Pharmacological interventions for self-harm in adults.

Area of Science:

• Mental Health Research
• Pharmacological Interventions
• Clinical Trials

Background:

• Self-harm (SH) is a growing global concern, often repeated and linked to suicide.
• Evidence for pharmacological treatments of SH is scarce compared to psychosocial interventions.
• This review updates previous findings on pharmacological interventions for adult SH.

Purpose of the Study:

• To assess the effectiveness of pharmacological agents or natural products for SH.
• To compare these treatments against placebo or alternative pharmacological treatments.
• To evaluate outcomes in adults (18+ years) with recent SH episodes.

Main Methods:

• Searched major databases (Cochrane, MEDLINE, Embase, PsycINFO) up to July 2020.
• Included randomized controlled trials (RCTs) of pharmacological agents/natural products versus placebo/alternative treatments.
• Primary outcome: repeated SH within two years; secondary outcomes: acceptability, adherence, depression, hopelessness, functioning, suicidal ideation, suicide.

Main Results:

• Included 7 trials with 574 participants (predominantly female, mean age 35.3 years).
• Uncertainty exists regarding antidepressants' effect on SH repetition (very low-certainty evidence).
• Antipsychotics showed potential for reduced SH repetition versus placebo (low-certainty evidence), but not versus other drugs. Mood stabilizers and natural products showed no significant difference.

Conclusions:

• Low-quality evidence and small trial numbers limit conclusions on pharmacological interventions for SH.
• More large-scale RCTs are needed, focusing on newer agents like atypical antipsychotics.
• Future research should also evaluate adverse effects and combined pharmacotherapy with psychological treatments.