Effectiveness of Atomoxetine Augmentation in Reducing Nonsuicidal Self-Injury Among Adolescents with Attention Problems: A Preliminary Study

Objective: This article presents the protocol for an open-label clinical trial examining the effectiveness of atomoxetine augmentation in adolescents with nonsuicidal self-injury (NSSI) and attention problems and reports preliminary findings from the initial group of participants. Methods: Adolescents (n = 27) aged 13-18 years who met the criteria for NSSI according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and had either full or subclinical attention-deficit/hyperactivity disorder (ADHD) were recruited. All participants had not received ADHD medication for at least 4 weeks prior to enrollment. Psychiatric diagnoses were confirmed using the Kiddie Schedule for Affective Disorders and Schizophrenia. After 12 weeks of adjunctive atomoxetine treatment, NSSI severity (primary outcome) was measured using the Inventory of Statements About Self-Injury. Secondary outcomes included the Children's Depression Rating Scale (CDRS), the Children's Depression Inventory (CDI), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and DuPaul's ADHD Rating Scale (ARS). Additional assessments targeting factors related to NSSI included demographic characteristics, childhood adversity, personality functioning, continuous performance task, and functional near-infrared spectroscopy. Results: Twenty-three participants (22 female, 1 male) completed the trial (mean final dose: 58.3 ± 13.7 mg), while four discontinued (two voluntarily, two due to adverse events). Significant improvements were observed in CDRS (p < 0.001), CDI (p = 0.031), and NSSI severity (p = 0.007). In the ADHD group, significant improvements were observed in CDRS (p = 0.017) and NSSI severity (p = 0.034), with a trend toward improvement in CDI (p = 0.058). The subclinical ADHD group showed significant improvement in CDRS (p = 0.006), with a trend toward improvement in NSSI severity (p = 0.083). Conclusion: Atomoxetine augmentation may reduce NSSI severity in adolescents with attention problems, particularly in those with comorbid ADHD, warranting further investigation in larger controlled trials.