A Cochrane review included 7 studies witha total of 546 participants. Of the 6 trials that reported information on gender, the majority of participants were female (63.5%). The trials included investigated the effectiveness of various pharmacological agents: mianserin, nomifensine, paroxetine, antipsychotics, lithium and natural products (omega-3 essential fatty acid; n-3EFA). The patients had had an episode of self harm within 6 months. We found no significant treatment effect on repetition of self harm for newer generation antidepressants (OR 0.76, 95% CI 0.42 to 1.36; 3 trials, n=243), low-dose fluphenazine (OR 1.51, 95% CI 0.50 to 4.58; one trial, n=53), mood stabilisers (OR 0.99, 95% CI 0.33 to 2.95; one trial, n=167), or natural products (OR 1.33, 95% CI 0.38 to 4.62; one trial, n=49). A significant reduction in self harm repetition was found in a single trial of the antipsychotic flupenthixol (OR 0.09, 95% CI 0.02 to 0.50; one trial, n=30). No data on adverse effects, other than the planned outcomes relating to suicidal behaviour, were reported.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), inconsistency (heterogeneity in treatments) and imprecise results (few trials for each comparison).