<p>Depression is frequently accompanied by various somatic symptoms such as sleep disturbances, pain, and gastrointestinal discomfort, which significantly impair patients’ quality of life. Acupuncture, a traditional Chinese medicine therapy, has gained increasing attention in recent years for its promising efficacy in alleviating both depressive symptoms and associated somatic manifestations. This review provides a comprehensive overview of the latest advances in the mechanistic research of acupuncture for treating somatic symptoms of depression, highlighting key areas including modulation of neurotransmitters, alterations in brain functional activity, epigenetic gene regulation, and immune-inflammatory responses. In addition, clinical trial data are systematically examined to evaluate the therapeutic value and safety of acupuncture across different depressive subtypes and related disorders. By integrating recent findings from both clinical and basic research, this article aims to establish a scientific foundation for the theoretical understanding and clinical application of acupuncture in managing somatic symptoms of depression, while also discussing potential directions for future investigations.</p>