Objective: Major depressive disorder (MDD) is the most common and serious problem-causing mental disorders. Although antidepressants and cognitive behavioral therapy are recommended as the main MDD treatments, they have limitations. Complementary and integrative medicine including acupuncture for overcoming the limitations of existing treatments for depression has been suggested in several clinical practice guidelines (CPGs). The CPG for depresion using Korean medicine treatment (KMT) including herbal medicine, acupuncture, and mind-body intervention was developed for the first time in 2016. We have updated the existing guidelines to reflect the latest evidence according to manuals and standard templates. In this presentaion, we focus recommendations for acupuncture in the CPG. Methods: A committee comprising clinical and methodological experts was formed, and clinical questions were developed. A systematic review was conducted for each clinical question. The randomized controlled trials of KMT for adult with MDD including menopause and perinatal women with MDD were selected and reviewed. A meta-analysis was conducted to evaluate the efficacy and safety of KMT for depression. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation. Recommendations were formulated considering the benefits and harms, the level of evidence, the utilization in the clinical practice settings, and patients’ values and preferences. A formal consensus was reached among the experts using the Delphi method. The final recommendations was approved by the Korean Society of Oriental Neuropsychiatry. Results: In total, 9 recommendations for manual acupuncture (MA) or electroacupuncture (EA) were developed (acupuncture alone 5, acupuncture combination treatment with herbal medicine 2, and acupuncture combination treatment with antidepresant 2). MA (Recommendation grade: B/Evidence level: Very Low) or MA combined with antidepressants (B/Low) should be considered to improve depression in adults with MDD than antidepressants. EA (C/ Low) or EA combined with antidepressants (C/Low) may be considered to improve depression in adults with MDD than antidepressants. MA should be considered to improve menopause depression than using antidepressants (B/Low). MA may be considered to improve prenatal depression (C/Low). EA may be considered to improve postpartum depression (C/Low). Conclusion: This guideline could assist Korean medicine doctors in clinical practice setting to provide evidence-based, standardized treatment for improving depression in adults with MDD. Consequently, implementing this guideline is expected to improve the acessibility of adults with MDD to primary healthcare and to provide a reliable and validated healthcare service using KMT.