The lifetime prevalence of depressive disorders in China reaches as high as 6.9%, with over 95 million current patients. The chronic course and high recurrence rate of this condition not only impose significant physical and psychological burdens on patients and their families but also create a substantial social burden. Non-pharmacological treatment constitutes a crucial component of comprehensive clinical intervention throughout the entire course of depressive disorders. Acupuncture therapy for depressive disorders, with its distinct advantages of remarkable efficacy, low cost, and minimal adverse effects, has become an important research direction in future depression treatment. The onset of depressive disorders is closely associated with abnormalities in neural reflexes and neural circuits. Acupuncture therapy guided by the principle of "treating depression from the spleen" addresses the limitations of single-focused treatment approaches targeting the liver, better aligning with the pathological characteristics of chronic, recurrent depressive disorders characterized by a mixture of deficiency and excess symptoms. Stimulation of acupoints related to the spleen has been proven to activate peripheral nerve endings, trigger relevant neural reflexes, influence central neural circuits, and alleviate depressive symptoms. Therefore, this article reviews the neuroregulatory mechanisms underlying acupuncture therapy for depressive disorders under the guidance of the “treating depression from the spleen” theory in recent years, aiming to provide insights and references for future research.