Depression

What is Depression?

Depression is a mood disorder marked by persistent sadness or loss of interest, along with physical and thinking changes that interfere with daily life.^[1] It is a medical condition, not a weakness or a mood that a person can simply decide to snap out of.

Common symptoms

The core symptoms are a depressed mood and loss of interest or pleasure in activities once enjoyed. Others include fatigue, sleep and appetite changes, trouble concentrating, feelings of guilt or worthlessness, and recurrent thoughts of death.^[2]

Depression can also show up as aches, irritability or withdrawal from other people.^[1]

Causes and risk factors

Depression cannot be explained by one cause. It appears to arise from a combination of genetic, environmental, psychological and biological factors.^[2] Stressful life events, other medical illness, hormonal change and family history are among the contributors.^{[2, 3]}

How it is diagnosed and treated conventionally

A clinician diagnoses depression from an interview and standard criteria, such as those in the DSM-5. The condition is classed into several types, including major depressive disorder and persistent depressive disorder.^[1]

Treatment commonly involves antidepressant medicines, psychotherapy, or both. For severe or treatment-resistant depression, other biological therapies such as electroconvulsive therapy may be offered.^[2] Response to antidepressants varies from person to person.^[1] Many people never seek help, which is one reason early assessment matters.^[1]

Why Depression calls for a whole-person approach

Depression involves the mind, body and daily life together. Sleep, inflammation, hormones and stress each interact with mood, so treating mood alone can leave other contributors in place.

Complementary care that supports sleep, stress and physical health can sit alongside medication and therapy. It is not a replacement for them.

Sleep

Sleep problems and depression often occur together and affect each other in both directions. In a meta-analysis of 23 studies of people with both conditions, treating insomnia was associated with improved depression scores, though many individual results were not statistically significant.^[4]

Inflammation

Higher levels of inflammatory markers are associated with depression. A meta-analysis found that C-reactive protein and interleukin-6 were each positively associated with depression, with small effect sizes.^[5] The direction of cause is not settled, and the evidence is consistent with inflammation leading to depression, depression leading to inflammation, or both.^[5]

Hormonal change

Hormonal transitions can raise vulnerability. A systematic review of 22 studies concluded that menopause increases vulnerability to depression and anxiety, with hot flashes and a prior history of major depression adding to the risk.^[3]

Stress and daily life

Psychological and environmental factors, including chronic stress and adverse life events, are part of the picture in depression.^[2] Some herbs used in Ayurveda, such as ashwagandha, are studied partly for effects on the body's stress-response system.^[6]

Acupuncture for Depression

What the research shows

Research suggests acupuncture may help reduce depressive symptoms, but most of the evidence is low certainty. A Cochrane review of 64 studies with 7,104 participants found low-quality evidence that acupuncture may moderately reduce depression severity compared with no treatment, and a small reduction compared with sham acupuncture. Evidence on acupuncture against medicine, or added to medicine, was rated very low quality, and the authors called for high-quality trials.^[7]

A 2025 review of 60 trials in mild to moderate major depression found low-certainty evidence that acupuncture, alone or added to antidepressants, may reduce depression severity compared with antidepressants, with mild and transient side effects. The authors rated the certainty of the evidence as very low overall.^[8] Another meta-analysis of 43 trials reported benefit over sham acupuncture and antidepressants and rated its evidence more favorably.^[9] The reviews therefore differ in how they grade the same body of research.

Individual sham-controlled trials give mixed but mostly positive results. In 64 people with subthreshold depression, real acupuncture reduced Hamilton scores by about 4 points more than sham over 8 weeks.^[10] In 120 people with moderate to severe depression taking an SSRI, adding intradermal acupuncture reduced scores more than adding sham or taking the SSRI alone.^[11] An auricular (ear) acupuncture trial in 74 adults found no significant difference in depression recovery between real and non-specific points at 3 months, although remission was higher with the specific points.^[12]

For people who have both depression and insomnia, a trial of 270 patients found electroacupuncture improved sleep quality more than sham acupuncture or standard care alone, with benefit lasting 24 weeks after treatment. Depression scores also fell in the electroacupuncture group.^[13] Most trials were done in China.

How acupuncture may work

How acupuncture might affect mood is not established. In the intradermal acupuncture trial, brain imaging suggested changes in connections between the striatum and other brain areas in patients who received active treatment.^[11] Better sleep may be another route, since treating insomnia has been linked to improved depression.^[4] These are early findings, not settled explanations.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the body, and sometimes the ear, usually left in place for about 20 to 40 minutes. The trials above gave sessions over 6 to 8 weeks, for example 10 sessions over 6 weeks and 24 sessions over 8 weeks.^{[11, 13]} We reassess after a short course of visits.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[14] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Depression

The Ayurvedic view

Ayurveda does not have a single category identical to depression. Low mood and withdrawal are traditionally described in terms of imbalance of the doshas, often with heaviness and dullness (Kapha) or depletion and anxiety (Vata), and a disturbed mind and sleep. Classical texts name conditions such as Vishada (despondency). These are traditional frameworks, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Regular meal, sleep and activity routines
• Breathing practices, meditation and gentle yoga
• Herbs traditionally used for stress and the mind, such as ashwagandha (Withania somnifera) and turmeric, prescribed individually by a practitioner; ashwagandha is used in Ayurveda for stress and has been studied for mood^[6]
• Warm oil massage and Shirodhara, a stream of warm oil over the forehead

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and is not suitable for someone in a severe depressive episode or at risk of self-harm.

What the research shows

The evidence is limited. We found no systematic reviews or large trials of whole Ayurvedic treatment programs for depression. Evidence comes from single herbs.

A review of ashwagandha studies found that it improved symptoms of depression and insomnia, though fewer studies examined these than stress and anxiety, and extracts varied widely.^[6] Turmeric is covered in the herbal section below. Yoga, often practiced alongside Ayurveda, is outside the clinic's listed services and is not reviewed here.

Herbal medicine for Depression

Herbs and formulas that have been studied

Most research on herbs for depression concerns Western herbs, including St John's wort, saffron and curcumin (from turmeric). A 2022 clinical guideline from two international psychiatric societies gave St John's wort, saffron and curcumin positive recommendations for depression, with the highest rating for St John's wort.^[15] Chinese herbal formulas are commonly used in practice, but we found no systematic review establishing their effect in depression.

What the research shows

The evidence is moderate for a few single herbs and limited for others. The same guideline said such agents should mainly be used alongside standard medical care, especially in more severe illness, and that product quality and standardization limit confidence.^[15]

A meta-analysis of 14 trials found St John's wort extract reduced depression scores and had fewer side effects than SSRIs, though results varied between trials.^[16] A meta-analysis of 10 trials with 594 patients found curcumin reduced depressive symptoms modestly, and the authors rated the evidence as low quality.^[17] A network meta-analysis of nutraceuticals reported that saffron performed well on its own, and that curcumin performed well on its own or added to antidepressants.^[18]

Safety and herb-drug interactions

Herbs for depression carry real interaction risks. St John's wort has caused serotonin syndrome when combined with SSRI antidepressants such as sertraline and paroxetine. It has also lowered blood levels of other drugs, including ciclosporin, warfarin and tacrolimus, and has been linked to unplanned bleeding with oral contraceptives.^[19] Because of this, never combine herbs with antidepressants without your prescriber's knowledge.

In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes depression as stagnation of liver qi, sometimes with spleen or heart deficiency. Researchers study things that loosely parallel this picture, including stress-response signaling, inflammation, sleep regulation and brain network connectivity.^{[5, 11]}

Ayurveda's description of aggravated Vata or Kapha in low mood parallels the sleep and energy changes seen in depression, and its stress-calming herbs are studied for effects on the stress-response system.^[6] No study has shown that a dosha or TCM pattern corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for depression is complementary. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Do not stop or change antidepressants or other prescribed treatment without your prescriber, since stopping suddenly can be harmful.

We do not diagnose or manage depression itself. Please bring your diagnosis, a full list of medicines and supplements, and any recent test results. Tell us about any past thoughts of self-harm, and make sure your treating team also knows what care you are receiving.

When to seek urgent medical care

Depression can become an emergency, and thoughts of suicide need immediate attention.

• Thoughts of suicide, self-harm or harming others
• A plan or means to end your life
• Hearing or seeing things that are not there, or strongly held false beliefs
• Not eating, drinking or caring for yourself
• Sudden severe agitation, or extreme highs with little sleep
• New confusion or a major change in behavior

If you are in crisis, call or text 988, the Suicide and Crisis Lifeline. For any emergency, call 911 or go to the nearest emergency department.