Evaluation of the Effectiveness of Auricular Acupuncture in Suicidal Ideation and Cortisol Level in Dysthymic Patients with Comorbid Opiate Use Disorders Enrolled in Methadone Maintenance Treatment: A Randomized, Double-Blind, Sham-Controlled Trial

Abstract

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.

The Effectiveness of Auricular Acupuncture on the Levels of Cortisol in a Depressed Patient

“…The secondary results of this study showed that acupuncture reduced the severity of suicidal ideation. These results are consistent with the findings of another study (5). In line with the findings of the present study, electro-acupuncture by modulating the HPA axis function and enhancing the activity of the hippocampus was associated with reduced symptoms of depression (8).…”

“…Secondary outcomes also showed that acupuncture was associated with a reduction in suicidal ideation. In line with the primary outcomes of the present research, the use of acupuncture through promoting adrenocorticotropic hormone and the secretion of plasma cortisol led to regulation of HPA axis activity in the mice with asthma (4, 5, 7).…”

“…1). Several studies have been conducted on the effectiveness of acupuncture on cortisol level (4, 5). Acupuncture has been associated with the regulation of HPA activity, improving the performance of adrenocorticotropic hormone and controlling of cortisol secretion (4).…”

Auricular Acupuncture for Suicidal Ideation in Methadone Patients

“…Overall, 24 methadone patients with the diagnosis of depression received either auricular acupuncture (AA) or sham acupuncture during four weeks. Interestingly, participants in the treatment group showed significantly better results than the control group in term of reduced suicidal ideation (10).…”

“…In a recent published article in your journal, "evaluation of the effectiveness of auricular acupuncture in suicidal ideation and cortisol level in dysthymic patients with comorbid opiate use disorder enrolled in methadone maintenance treatment: a randomized double-blind, sham controlled trial", authors have suggested a new intervention to treat suicidal ideation in methadone therapy in Iran (10). Overall, 24 methadone patients with the diagnosis of depression received either auricular acupuncture (AA) or sham acupuncture during four weeks.…”