Psychotropic drugs for the treatment of non-suicidal self-injury in children and adolescents: a systematic review and meta-analysis

Abstract

Non-suicidal self-injury (NSSI) in children and adolescents is a frequent phenomenon. NSSI at any time is a significant predictor of future NSSI but also, and more importantly, for suicide attempts. Less evidence is available for the impact, or more specifically, the therapeutic effect of psychotropic drugs on the emergence of NSSI in this population. The phenomenon is clinically highly relevant since adolescent psychiatric inpatients are often affected by NSSI and most of them are treated with psychotropic drugs. While previous reviews on NSSI comprised suicidal self-injury (SSI), this review aims at elucidating the potential impact of psychotropic drugs on the emergence of specifically NSSI in children and adolescents. Systematic searches of articles indexed electronically in PubMed, Embase and PsycInfo were conducted (PROSPERO CRD42020209505). Studies included in the quantitative synthesis were evaluated using the SIGN level of evidence rating. Meta-analyses were performed using RevMan (Version 5.4). 2227 records were identified through database searches. Two additional records were identified manually. In total, seven studies were included in qualitative and four studies in quantitative analyses. In a meta-analysis, selective serotonin reuptake inhibitors (SSRIs) were compared vs. control medication (placebo or serotonin-norepinephrine reuptake inhibitor) and here, no statistically significant difference between the groups could be observed regarding the frequency of NSSI events (Risk Ratio (RR) = 1.07, 95% confidence interval (CI) 0.60-1.91, p = 0.82, I 2 = 12%). Evidence regarding the association of SSRI use and NSSI among children and adolescents is sparse and the impact of psychotropic drugs in general on NSSI rates in this population should be addressed in future clinical and observational studies.

Association of Four Medication Classes and Non-suicidal Self-injury in Adolescents with Affective Disorders – A Retrospective Chart Review

“…Thus, we aimed to investigate the impact of different medication classes on the occurrence of NSSI in the context of established NSSI risk factors in a large retrospective cohort of adolescent inpatients with both affective and non-affective disorders. Based on the evidence described above and the clinical impression of the authors, we expected an accumulation of NSSI in times of medication with benzodiazepines, and based on our metanalyses published ahead [30], no association of SSRIs and NSSI in adolescents.…”

“…In general, combined psychotherapeutic and pharmacological treatment is recommended as a first-line treatment for moderately to severely ill depressive adolescents [29], but the impact of psychoactive drugs on NSSI rates in this population remains elusive [30]. Thus, we aimed to investigate the impact of different medication classes on the occurrence of NSSI in the context of established NSSI risk factors in a large retrospective cohort of adolescent inpatients with both affective and non-affective disorders.…”

Prefrontal cortex neural activity predicts reduction of non-suicidal self-injury in adolescents with major depressive disorder: An event related potential study

“…Glenn found that among adolescents with anxiety disorder, the frequency of self-injury in the intervention group combined with fluoxetine decreased significantly compared with adolescents who only used cognitive behavioral therapy ( Melvin et al, 2019 ). However, a recent meta-analysis of psychotropic drugs for the treatment of NSSI in children and adolescents showed that there was no statistically significant difference in the occurrence of NSSI in adolescents between SSRI and the control group (drug or placebo) ( Eggart et al, 2022 ). Whether there is a recommended drug choice for NSSI behavior of adolescents needs to be carried out in a larger randomized controlled study in the future.…”

Pharmacological Support Treatment of Non-Suicidal Self-Injuries Among Children and Adolescents: A Narrative Review

“…In a meta-analysis conducted by Eggart et al [30], SSRIs were compared with control medication (placebo or SNRIs), and no statistically significant difference between the groups was observed in terms of the reduction of frequency of NSSI undertaken. However, the authors made a point that the number of studies included in this meta-analysis and their quality are insufficient to draw clear conclusions [30].…”