Speech-Language Pathology/Stuttering/Anti-Stuttering Medications

Dopamine Antagonist Medications

Psychiatrist would like to use dopamine antagonists to reduce stuttering. However, these medications have side effects. Also, the long-term effects of the following medications are unknown. In some patients, even placebo can temporarily reduce stuttering. Rather than taking medication indefinitely, it may be better for a severe stutterer to take a medication at the start of a stuttering therapy program, and then reduce his dosage as his fluency improves, until he no longer needs the medication.

If you suspect that your child’s medication contributes to his or her stuttering—especially if your child is on several medications—I suggest that you consult a doctor. No drug has been more effective than placebo in clinical trials.

Haldol

Haloperidol (Haldol) is an old dopamine antagonist. It was the first medication to reduce stuttering in two clinical trials.

The side effects can be severe.

Risperdal

Newer medications more narrowly target certain dopamine receptors. The dopamine D2-receptor antagonist risperidone (Risperdal) reduces stuttering about 50%. Like other stuttering therapies, the drug is most effective in low-stress situations, and least effective in high-stress situations.

The drug is FDA-approved only for short-term (6-8 week) treatment of schizophrenia. Side effects include insomnia, agitation, anxiety, somnolence, extrapyramidal nervous system disorders, headaches, dizziness, constipation, rhinitis (a breathing disorder), rashes, tachycardia (a heart disorder), and breast growth in men and women (due to increased levels of the hormone prolactin), and neuroleptic malignant syndrome (potentially fatal).

Zyprexa

Olanzapine (Zyprexa) reduces stuttering on average 33%. Side effects may include permanent damage to the frontal lobe, weight gain, and drowsiness.

Other Dopamine Antagonists

Pimozide and Tiapride are other dopamine antagonists that have been reported to help stutterers. Pagoclone is currently being tested on stutterers.

Antidepressants Increase Stuttering

Some antidepressant medications boost dopamine. These medications include the selective serotonin reuptake inhibitor (SSRI) class, which includes Prozac and Zoloft. These medications have increased stuttering in stutterers. In a few cases, these drugs caused non-stutterers to stutter.

However, there is no real evidence of this.

Another stutterer wrote:

I have tried 3 antidepressants: Prozac, Wellbutrin, and Zoloft. All increased my stuttering noticeably. The antidepressants that I have tried make me more able to get out of bed in the morning and restore my "get up and go"; however, they have caused me to go from being a person with a barely noticeable stutter to a more pronounced stutter. I had more occasions to talk.

I went into my psychiatrist yesterday and explained that the current antidepressant is making my stutter significantly worse. However, in the 10 minutes we talked I was practically perfectly fluent. He then concludes that obviously "it's not that unmanageable."

He prescribed 10mg Propanolol to take before I have to be in a difficult speaking presentation. It is supposed to "reduce performance anxiety." I don't feel like I have a tremendous amount of performance anxiety; stuttering just isn't very fun. I think he doesn't believe me about the severity of the stuttering.

Anti-Depressants and Stutter

I have tried one tri-cyclic anti-depressant called Trazodone, 150mg/day. After about a month of taking the pills I experienced mild to serious stuttering. I never remembered stuttering before or never had anyone comment on my stutter. The stutter brought on even worse anxiety while still on the pills. I then found myself having worse performance anxiety as well.

A month after stopping the regular taking of the pills my stutter was almost completely absent.

Other Medications and Drugs

Ritalin

A speech pathologist asked on the Internet:

I'm treating an 8-year-old diagnosed ADHD and who suddenly began stuttering (advanced core and secondary behaviors) without any prior history of dysfluency, as a side effect of the medication Ritalin. He's had a whole neuro work-up which revealed nothing.

Another speech pathologist responded that many of the children he treated for stuttering were on Ritalin for ADHD.

Pharmacist Richard Harkness advises against Ritalin for children who stutter:

Ritalin increases dopaminergic neurotransmission and is contraindicated for use in those with Tourette's disorder. Ritalin has also, in rare cases, brought on symptoms of Tourette's disorder. Tourette's disorder has been likened to stuttering in that it involves a flaw in dopaminergic neurotransmission.

Botulinum Toxin

Botox, the toxin in botulism, has been injected into stutterers' vocal folds. The toxin partially paralyzes your vocal folds so you can't get into hard blocks. You also can't talk loudly or forcefully. The toxin reduces stuttering somewhat. It wears off in a few months, and you get a second shot. The second shot reduces stuttering less than the first. By the third shot, the toxin usually has no effect on stuttering.

Tranquilizers

Some doctors prescribe tranquilizers to stutterers on the erroneous belief that nervousness causes stuttering.

A psychiatrist had some pills he thought might help. Einer was to take one per day during the week remaining before the great day, and one extra big super pill on the morning of the wedding. The pills made him feel somewhat relaxed but had no noticeable effect on his speech. The wedding arrived, Einer took his super pill, and went off to London on the train to meet his relatives who had come for the ceremony.

An hour before the wedding Einer had still not returned. I kept the smiling calm that I had learned to assume in the face of all our difficulties and began dressing. Half an hour later I stood in white satin complete with veil and bouquet, looking out of the bedroom window towards the railway station, wondering what could have happened and preparing myself mentally for a last minute cancellation of the wedding. Had he thrown himself under a train, unable to continue life as a stutterer? Had he run back to Canada as a supreme act of avoidance? The minutes ticked by. Finally another train pulled in, and up the hill walked Einer, a lazy smile on his face, apparently unaware of the panic that he had caused. He had forgotten to take pencil and paper and so was unable to ask for guidance and had become hopelessly lost. However, the super pill had kept him smiling. I am glad to say that thanks to the kindly vicar in reading along with Einer, the wedding vows were the first and only fluent words my family heard Einer speak that summer.>

In general, tranquilizers have "more effect on the complexity or severity of the [stuttered] blocks than on their frequency."

Alcohol

No researchers have studied the effects of alcohol on stuttering. Anecdotally, alcohol reduces stutterers' fears and anxieties (e.g., about talking to persons of the opposite sex) and so reduces stuttering. But alcohol reduces one's ability to use therapy techniques, so increases stuttering.

Experiences with Anti-Stuttering Medications

Please read Speech-Language Pathology/Stuttering/How to Participate in this Wikibook before adding material to this section.

References

1. ^ Maguire, G., Riley, G.D., Wu, J.C., Franklin, D.L., Potkin, S. "Effects of risperidone in the treatment of stuttering," in Speech Production: Motor Control, Brain Research and Fluency Disorders, edited by W. Hulstijn, H.F.M. Peters, and P.H.H.M. Van Lieshout, Amsterdam: Elsevier, 1997; Riley, G.D., Maguire, G. "National Enquirer Article" memo, 1998.
2. ^ Riley, Glyndon. "Medical Aspects Of Stuttering," Stuttering Foundation Of America newsletter, Summer 2002.
3. ^ Gottlieb, Jeff. "Easier for Him to Say," Los Angeles Times, April 3, 2002.
4. ^ Stager, S., Calis, K., Grothe, D., Bloch, M., Turcasso, N., Ludlow, C., Braun, A. "A Double-Blind Trial of Pimozide and Paroxetine For Stuttering," in Speech Production: Motor Control, Brain Research and Fluency Disorders, edited by W. Hulstijn, H.F.M. Peters, and P.H.H.M. Van Lieshout, Amsterdam: Elsevier, 1997.
5. ^ Rothenberger, A., Johannsem, H., Schulze, H., Amorosa, H., Rommel, D. "Use of Tiapride on Stuttering in Children and Adolescents," Perceptual and Motor Skills, 1994, 79, 1163-1170.
6. ^ Butcher, S. Stut-hlp posting, January 27, 1998. Reprinted with permission.
7. ^ Boberg, Julia. Institute for Stuttering Research and Treatment, Edmonton, Alberta. Reprinted with permission.
8. ^ Bloodstein, Oliver (1995) A Handbook On Stuttering, 5th edition, San Diego: Singular Press.