Efficacy of psychotropic medications on suicide and self-injury: a meta-analysis of randomized controlled trials
Abstract Using psychotropic medications to treat and prevent self-injurious thoughts and behaviors (SITBs) has become increasingly popular, but conclusive evidence supporting the efficacy this approach remains elusive. To empirically examine whether psychotropic medications are efficacious treatment...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Nature Publishing Group
2022-09-01
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| Series: | Translational Psychiatry |
| Online Access: | https://doi.org/10.1038/s41398-022-02173-9 |
| _version_ | 1811208684377735168 |
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| author | Xieyining Huang Lauren M. Harris Kensie M. Funsch Kathryn R. Fox Jessica D. Ribeiro |
| author_facet | Xieyining Huang Lauren M. Harris Kensie M. Funsch Kathryn R. Fox Jessica D. Ribeiro |
| author_sort | Xieyining Huang |
| collection | DOAJ |
| description | Abstract Using psychotropic medications to treat and prevent self-injurious thoughts and behaviors (SITBs) has become increasingly popular, but conclusive evidence supporting the efficacy this approach remains elusive. To empirically examine whether psychotropic medications are efficacious treatments for SITBs, the present meta-analysis comprehensively summarizes all published randomized controlled trials (RCTs) that have reported the causal effects of psychotropic medications on suicide and self-injury. A total of 251 papers from 718 unique RCTs were included. A frequentist pairwise approach was adopted for meta-analyses. Potential effect modifiers were examined via met regressions and potential biases were evaluated through sensitivity analyses. On average, medications yielded an 8% reduction in SITB frequency and a reduction of 0.2 standard deviations in symptoms and severity. Findings were largely consistent across potential effect modifiers, and significant evidence of publication bias was not detected. Only one medication class (i.e., antipsychotics) and two specific medications (i.e., citalopram, ketamine) produced larger-than-average treatment effects. Psychostimulants and typical antipsychotics may produce iatrogenic effects. Less than 4% of included studies required individuals to exhibit SITBs, and nearly half of analyzed effects were drawn from studies that excluded individuals on the basis of SITB risk. Taken together, findings suggest that psychotropic medications produce small treatment effects on SITBs; however, these findings should be considered in light of the methodological constraints of the existing literature, including the lack of studies intentionally including individuals with SITBs. It is critical for future RCTs to prioritize including individuals with existing SITBs to further clarify treatment effects in self-injurious and suicidal populations. Additional research is needed to better understand the treatment mechanisms of psychotropic medications and identify the causal processes underlying SITBs. |
| first_indexed | 2024-04-12T04:25:46Z |
| format | Article |
| id | doaj.art-795e4ebe33df4f96889636f2c65ecd25 |
| institution | Directory Open Access Journal |
| issn | 2158-3188 |
| language | English |
| last_indexed | 2024-04-12T04:25:46Z |
| publishDate | 2022-09-01 |
| publisher | Nature Publishing Group |
| record_format | Article |
| series | Translational Psychiatry |
| spelling | doaj.art-795e4ebe33df4f96889636f2c65ecd252022-12-22T03:48:05ZengNature Publishing GroupTranslational Psychiatry2158-31882022-09-0112111610.1038/s41398-022-02173-9Efficacy of psychotropic medications on suicide and self-injury: a meta-analysis of randomized controlled trialsXieyining Huang0Lauren M. Harris1Kensie M. Funsch2Kathryn R. Fox3Jessica D. Ribeiro4Department of Psychology, Florida State UniversityDepartment of Psychology, Florida State UniversitySchool of Behavioral and Brain Sciences, University of Texas at DallasDepartment of Psychology, University of DenverDepartment of Psychology, Florida State UniversityAbstract Using psychotropic medications to treat and prevent self-injurious thoughts and behaviors (SITBs) has become increasingly popular, but conclusive evidence supporting the efficacy this approach remains elusive. To empirically examine whether psychotropic medications are efficacious treatments for SITBs, the present meta-analysis comprehensively summarizes all published randomized controlled trials (RCTs) that have reported the causal effects of psychotropic medications on suicide and self-injury. A total of 251 papers from 718 unique RCTs were included. A frequentist pairwise approach was adopted for meta-analyses. Potential effect modifiers were examined via met regressions and potential biases were evaluated through sensitivity analyses. On average, medications yielded an 8% reduction in SITB frequency and a reduction of 0.2 standard deviations in symptoms and severity. Findings were largely consistent across potential effect modifiers, and significant evidence of publication bias was not detected. Only one medication class (i.e., antipsychotics) and two specific medications (i.e., citalopram, ketamine) produced larger-than-average treatment effects. Psychostimulants and typical antipsychotics may produce iatrogenic effects. Less than 4% of included studies required individuals to exhibit SITBs, and nearly half of analyzed effects were drawn from studies that excluded individuals on the basis of SITB risk. Taken together, findings suggest that psychotropic medications produce small treatment effects on SITBs; however, these findings should be considered in light of the methodological constraints of the existing literature, including the lack of studies intentionally including individuals with SITBs. It is critical for future RCTs to prioritize including individuals with existing SITBs to further clarify treatment effects in self-injurious and suicidal populations. Additional research is needed to better understand the treatment mechanisms of psychotropic medications and identify the causal processes underlying SITBs.https://doi.org/10.1038/s41398-022-02173-9 |
| spellingShingle | Xieyining Huang Lauren M. Harris Kensie M. Funsch Kathryn R. Fox Jessica D. Ribeiro Efficacy of psychotropic medications on suicide and self-injury: a meta-analysis of randomized controlled trials Translational Psychiatry |
| title | Efficacy of psychotropic medications on suicide and self-injury: a meta-analysis of randomized controlled trials |
| title_full | Efficacy of psychotropic medications on suicide and self-injury: a meta-analysis of randomized controlled trials |
| title_fullStr | Efficacy of psychotropic medications on suicide and self-injury: a meta-analysis of randomized controlled trials |
| title_full_unstemmed | Efficacy of psychotropic medications on suicide and self-injury: a meta-analysis of randomized controlled trials |
| title_short | Efficacy of psychotropic medications on suicide and self-injury: a meta-analysis of randomized controlled trials |
| title_sort | efficacy of psychotropic medications on suicide and self injury a meta analysis of randomized controlled trials |
| url | https://doi.org/10.1038/s41398-022-02173-9 |
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