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Pharmaceutical Approaches to Stuttering: Efficacy of Medications in Reducing Speech Dysfluency

This article reviews various pharmaceutical interventions aimed at reducing stuttering behaviors. It discusses drug trials involving Alprazolam, Citalopram, Risperidone, Olanzapine, and Pagoclone, highlighting their effects on stuttering severity and associated anxiety. Notable case studies reveal significant improvements in speech fluency and social interactions, with a focus on individualized treatment and the combination of medication with speech therapy. Although promising results are noted, concerns about long-term efficacy, side effects, and the need for ongoing research in stuttering treatment are emphasized.

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Pharmaceutical Approaches to Stuttering: Efficacy of Medications in Reducing Speech Dysfluency

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  1. Pharmaceutical Approaches to Stuttering Jennifer VanHulle Justine Siepmann Kristin Scheunemann

  2. Definition • The use of different medications to reduce primary and secondary behaviors of stuttering.

  3. Drug Trial: Alprazolam and Citalopram • Alprazolam-antianxiety • Citalopram-antidepressant • Study (by: John Paul Brady, M.D. and Zahir Ali, M.D.) • 57 year old physician with a severe stutter at the age of 4 • Previous Therapy/medications • minimal improvement in speech • Implemented Alprazolam (1 mg/twice a week) and Citalopram (10 mg/bedtime) • Initial Stuttering Rating Scale: 6 on 7 point scale (severe)

  4. Drug Trial: Alprazolam and Citalopram • Results • Prompt and dramatic response • Showed minimal signs of stuttering • Family, friends, and colleagues remarked on his increased fluency • Now speaks in situations that were originally fearful • Stuttering Rating Scale score decreased from 6 to 2 (mild) • 20th week: • Anxiety reduced allowing him to gradually discontinue medication but still continues to take Citalopram which reduces the core symptoms of stuttering.

  5. Drug Trial: Risperidone and Olanzapine • Study (by Gerald Maguire, M.D. and his team at the University of California) • Double-blind placebo-controlled study with 2 small groups that stutter • Risperidone: Group 16 adults • Olanzapine: Group 22 adults • Half of the subjects received a placebo and the other half received the active compound • Measures included: • Percentages of syllables stuttered and subjective scores (example: Patient’s perception of speech fluency)

  6. Drug Trial: Risperidone and Olanzapine • Results • The active drug of either trial was found to be superior in reducing the percentage of syllables stuttered to the placebo • Side effects • Risperidone • Sedation • Lack of menstrual periods • Olanzapine • Sedation • Weight gain

  7. Pagoclone(under development from Indevus Pharmaceuticals) • Study (2006) • Double-blind randomized design/placebo-controlled • Over 130 adults who stutter • Pagoclone affected a natural neurochemical in the brain known as GABA (plays a significant role in stuttering)

  8. Pagoclone(under development from Indevus Pharmaceuticals) • Results • Improved stuttering symptoms in over 50% of the individuals treated • Showed superior improvement compared to the placebo • Improved fluency of speech • Reduced social anxiety • Well tolerated with minor side effects • Headache • Fatigue

  9. Theoretical Rationale • Studies have shown that the use of medication is effective in reducing stuttering due to dopamine blocking medications • Reduction of stuttering results in decreased anxiety which lessens the amount of medication needed

  10. Style of Therapy • Individualized based upon: • The medication • The patient’s age, gender, and weight • The severity of stuttering • Speech therapy should be implemented with medication “…treatment will likely involve the combination of medication with speech therapy to achieve the optimal results.” -Gerald Maguire, M.D.

  11. Measurement of Success • Measured by: • Reduced percentage of syllables stuttered • Reduction of primary and secondary stuttering behaviors • Reduction of social anxiety • Improvement of quality of life • Decreased severity rating

  12. Generalization and Maintenance • Generalization: • No data was presented for this approach • Maintenance: • Consistently taking the prescribed medication

  13. Strengths Reduction of stuttering Reduction of stuttering behaviors Reduction of social anxiety Minimal effort Weaknesses Side effects Not a cure for stuttering Combination of medications could be fatal No long-term results available Unreliable justifications Strengths and Weaknesses

  14. Recommend? We do NOT recommend this approach • Lack of research on effectiveness • Long-term side effects are unknown • Medications are costly • Generalization is unknown

  15. Resources • Bradey, J., Ali, Z. (2000). Alprazolam, Citalopram, and Clomipramine for Stuttering. Retrieved November 12, 2007 from http://www.stutteringhelp.org/DeskLeftDefault.aspx?tabid=170 • Maguire, G. (2007). New drugs for stuttering may be on the horizon. Retrieved November 12, 2007 from http://www.stutteringhelp.org/Default.aspx?tabid=566 • Pollack, A. (2006). To Fight Stuttering, Doctors Take a Close Look at the Brain. Retrieved November 29, 2007 from http://www.nytimes.com/2006/09/12/health/12stutt.html • Sommer, M. (2006). One step closer to drug treatment of stammering. Retrieved November 28, 2007 from http://www.stammering.org/pagoclone.html

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