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Background: Suicide is one of the leading causes of death around the world. The hypothalamic-pituitary-adrenal (HPA) axis disorder is involved in the pathophysiology of suicidal behavior. Acupuncture by regulating the activity of the HPA axis could regulate the secretion of cortisol. Objectives: This study aimed to evaluate the effectiveness of auricular acupuncture in the reduction of cortisol level and suicidal ideation in dysthymic patients with comorbid opiate use disorders enrolled in methadone maintenance treatment (MMT). Methods: In a randomized, double-blind, sham-controlled trial (TCTR20180328001), from December 2015 to June 2016, 24 patients (mean age = 24 years) with persistent depressive disorder (dysthymia) under methadone maintenance treatment who referred to Bijan Center for Substance Abuse Treatment in Tehran were selected through respondent-driven sampling (RDS). After 28 days of evaluation, the participants were randomized into two active or sham continuous groups. Auricular acupuncture was performed twice a week for four weeks for the experimental group while the control group received the sham acupuncture. Assessments were carried out before treatment (baseline) and every week for four weeks. Salivary cortisol was considered the primary outcome and the suicide ideation was the secondary outcome. The data were analyzed by the generalized estimation equation (GEE) model and the chi-square test. The qualitative data were analyzed using ATLAS/TI 5 software. Results: Acupuncture had a significant effect on the cortisol level, as the primary outcome, during the four weeks of treatment. Moreover, there was a significant reduction in suicidal ideation as the secondary outcome (all P values < 0.01). Conclusions: Acupuncture as an alternative method could reduce the cortisol level and significantly decrease suicidal ideation.

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