Acupuncture is being increasingly used in psychiatric disorders. The effect of acupuncture on depression (including depressive neurosis and depression following stroke) has been documented repeatedly in controlled studies (189-194). Acupuncture is comparable with amitriptyline in the treatment of depression but has fewer side-effects. In addition, acupuncture has been found to be more effective in depressive patients with decreased excretion of 3-methyl-4-hydroxy-phenylglycol (the principal metabolite of the central neurotransmitter norepinephrine), while amitriptyline is more effective for those with inhibition in the dexamethasone suppression test (192). This suggests that these two therapies work through different mechanisms. There have also been reports that, in controlled trials of schizophrenia treatment, acupuncture might have a better effect than chlorpromazine (194, 195).
Acupuncture (auricular acupressure) is much more effective than psychotherapy in the treatment of competition stress syndrome, and is worth further study (196).
The possible use of auricular acupuncture as a treatment for opium dependence was first noted in 1973 (197). It was found that some of the patients whose postoperative pain was relieved by acupuncture were hiding a dependence on opium. In 1979, a study carried out jointly in Hong Kong and London showed that endorphin concentrations were raised by acupuncture in heroin-dependent persons, resulting in successful suppression of withdrawal symptoms. Since then, acupuncture has been used to treat dependence on a variety of substances. Many substance-abuse programmes use acupuncture as an adjunct to conventional treatment (198). Most of the reports are anecdotal, and while there have been several controlled trials (199-202), the findings have not been consistent. This entire field of research is still at an early stage, holding some promise, but requiring larger-scale and more demanding research studies (198).
Acupuncture treatment has also been used in patients who wish to give up smoking. The conclusions of different researchers are conflicting, however. Some favour acupuncture, while others dismiss its value (203-207). Probably the most convincing results are from randomized controlled trials of passive abstinence, with no suggestion or motivation to stop smoking. The patients were told they would receive acupuncture for other purposes, and they were not asked to stop smoking. A comparison of the effects of auricular acupuncture and body acupuncture was made: 70% of the auricular-acupuncture patients and 11% of those receiving body acupuncture either abstained totally from smoking or reduced the amount of consumption by half. In addition, 72% of the auricular-acupuncture patients experienced disgust at the taste of tobacco (204). However, in contrast, a meta-analysis of seven reports carefully selected from 16 controlled studies of smoking cessation indicated that acupuncture did not have any greater effect than the placebo (208).
Acupuncture has also been reported to be useful for treating alcohol recidivism. In placebo-controlled trials (with acupuncture at nonspecific points as the control), the patients in the treatment group expressed less need for alcohol than did the control patients. Patients in the treatment group also had fewer drinking episodes and admissions to a detoxification centre (209-211). It is interesting to note that in an experimental study on healthy volunteers, acupuncture diminished clinical alcohol intoxication by increasing the alcohol level in expired air and decreasing blood alcohol levels (212).