Dr. Bob's Psychopharmacology Tips

Stuttering

Date: Wed, 15 Mar 1995 08:11:41 -0500
From: Peter Como <como@etin.mct.rochester.edu>
Subject: Stuttering

We have recently begun to think of stuttering as a potential movement disorder. In fact if you compare the clinical phenomenology of movement disorders such as Tourette's and stuttering there are some striking similarities, e.g., age of onset, waxing and waning course, influenced by stress. Indeed many patients with TS have tics which resemble stuttering.

With regard to rx, we have had initial success in treating stutterers with clonidine which is also useful for suppressing tics and treating ADHD.

From: Suzannedoc@aol.com (Andrea B. Stone, M.D.)
Date: Sat, 3 Jun 1995 19:27:54 -0400
Subject: Stuttering

I have had excellent success treating a young man with social phobia, panic with agoraphobia and stuttering with phenelzine.

Propranolol had helped some with anxiety, but phenelzine has changed his life and, incidentally, nearly eliminated his stutter that had been present from childhood. There was a letter to the editor in the American Journal of Psychiatry within the last 2-3 years citing the success of phenelzine in stuttering.

Date: Sun, 4 Jun 1995 14:05:54 -0700 (PDT)
From: David M Ulansey <davidu@uclink.berkeley.com>
Subject: Stuttering

The letter you refer to was in American Journal of Psychiatry, Feb. 1993, 150 (2): 355-6.

Date: Mon, 10 Jul 1995 13:06:03 -0600
From: dr-bob@uchicago.edu (Robert Hsiung)
Subject: Stuttering

In this month's Am J Psychiatry, there's a Brief Report on "Lack of Effect of Clonidine on Stuttering in Children". It's 152 (7): 1087-1089 and from University Hospital, Groningen, the Netherlands.

Date: Thu, 8 Feb 1996 19:46:35 +1300
From: david.menkes@stonebow.otago.ac.nz (David Menkes)
Subject: Stuttering in schizophrenia

We've found that stuttering may rarely present as an early feature of schizophrenia, and in that case responds very well to high potency neuroleptics (in my hands trifluoperazine worked a treat -- J Nerv Ment Dis 1993, 181: 64-65). In other cases, "idiopathic" stuttering may respond marginally to such drugs, but is rarely worth the trouble due to side effects. Never had any luck with clonidine.

Date: Mon, 28 Oct 1996 22:45:34 -0500
From: Ivan Goldberg <Psydoc@psycom.net>
Subject: Stuttering as a medication side effect

I am unaware of any antidepressant that does not induce stuttering in the speech of some patients who take it.

Date: Tue, 29 Oct 1996 10:08:48 -0500
From: Norman Rosenthal <ner@box-n.nih.gov>
Subject: Stuttering

I have observed two cases of stammering on Wellbutrin. In considering the mechanism, I was interested to read recently of stammering being regarded as a sort of "traffic jam" of nerve signals passing through various gating mechanims in the brain. If this is so, I wonder whether the increased stimulation associated with the Wellbutrin (bupropion) exacerbated the "traffic" problem. Just a thought. Both patients stopped stammering after the wellbutrin dosage was decreased.

Date: Tue, 29 Oct 1996 16:53:08 -0800
From: "Kenneth W. Steinhoff" <ksteinho@uci.edu>
Subject: Stuttering

Antidepressants can worsen or even start stuttering.

Stuttering is a basal ganglia/pre-frontal cortex phenomena and is closely related to tics (Gerald Mcguire, M.D,. has produced PET scan data at our institution). The highest concentration of D2 mRNA levels are here as well as a high concentration of serotonin receptors. The relationship between the dopamine and serotonin systems is poorly understood (at least by me...).

Risperidone is a useful pharmacologic intervention for stuttering as well as tics.

Date: Tue, 29 Oct 96 20:46 PST
From: Charlene Sabin <sabin@hevanet.com>
Subject: Stuttering as a medication side effect

I recently had a young (6 years old) client who developed a speech pattern of younger children, hesitancy, on Zoloft (sertraline). Hesitancy, which is the repeating of words or phrases in the context of initiating a sentence, can be mistaken for stuttering, but it is developmentally appropriate in many 2-3 year old children. My client had many anxiety related behaviors and other psychosocial issues. The hesitancy he developed made him sound more anxious, but he seemed to feel calmer internally. The hesitancy was very bothersome to the adults around him, and the medication was discontinued due to this.

Date: Fri, 13 Dec 1996 16:18:03 -0800
From: "Kenneth W. Steinhoff" <ksteinho@uci.edu>
Subject: Stuttering

Both SSRIs and stimulants have been reported to exacerbate or even cause stuttering. Risperidone is helpful in the treatment of stuttering as noted earlier, but should be accompanied by an adequate work-up and speech therapy as well.

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