Medication for stuttering has always captured the imagination of people who stutter and their families. In the future we are not likely to see a magic fluency pill, but the combination of speech therapy and new pharmaceuticals may reduce the severity of stuttering.
Stuttering is classified as a neuropsychiatric disorder, and much has been learned in the past two decades about some of the underlying physiologic differences in the brains of people who stutter. Significant research has indicated that stuttering may be related to an abnormality in the function of the naturally occurring brain chemical, or neurotransmitter, dopamine.
Going back forty years, medications that lowered the activity of dopamine in the brain were found to be effective in reducing the severity of stuttering. Unfortunately, many of these older medications had side effects such as movement disorders and sexual dysfunction.
Two decades ago a new class of dopamine-blocking medications was developed. These medications are approved by the U.S. Food and Drug Administration for use in other dopamine-based disorders such as bipolar disorder, Tourette’s Disorder and Schizophrenia. Studies, many conducted in the rigorous design of having a placebo control (patients taking fake pills as a comparison) and being double-blind (neither doctor or patient know who’s taking the real pill), found these medications also to be effective in reducing the symptoms of stuttering.
These novel second-generation antipsychotic medications are still being modified. The newest versions have fewer side effects than the earlier compounds with less weight gain, sedation and lacking sexual side effects. With the growing evidence, physicians can legally prescribe these medications for stuttering in adults and teens because the compounds are FDA-approved for other conditions. However, no company has so far invested the hundreds of millions of dollars required to gain official FDA approval to market these drugs for specifically for stuttering. The University of California Riverside School of Medicine and the Kirkup Center for the Medical Treatment of Stuttering will soon begin a trial of a compound that has received FDA clearance to begin testing specifically for stuttering.
Pagoclone was a compound that was being investigated for FDA approval on stuttering. Unfortunately, the testing occurred at the time of the economic collapse and further funding was not pursued. The compound showed initial promise in the treatment of stuttering with suggestions that higher dosages may be effective in stuttering. This medication did not act on dopamine but rather on GABA, a neurotransmitter that has not been as clearly implicated in stuttering as dopamine.
Many of the novel, second-generation antipsychotic medications have approval for use in adolescents suffering from other neuropsychiatric disorders. Pharmacologic treatment of stuttering can be considered in older adolescents and adults when speech therapy has proven to be unsuccessful or being met with significant relapse.
Psychiatrists are the physicians best schooled in the prescription of this class of medication. Although not everyone treated may show a beneficial response, the evidence continues to grow that such treatment may be a viable option for those suffering from stuttering. Many individuals with stuttering also suffer from social anxiety related to their speech and the psychiatrist has many tools at his/her disposal, including psychotherapy and medication, to effectively treat these symptoms.
It’s likely that over the years, we eventually will have studies showing that medication combined with speech therapy will prove to be more effective than either treatment alone. At this point, these combined treatments will not be a cure but definitely can be effective in reducing the severity of stuttering.
By Gerald A. Maguire, MD, DFAPA, Professor and Chair, Psychiatry and Neuroscience, UC Riverside School of Medicine. For more information contact UC Riverside School of Medicine and the Kirkup Center via Gerald.firstname.lastname@example.org.