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Treatment with medications affecting dopaminergic and serotonergic mechanisms: effects on fluency and anxiety in persons who stutter |
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| Authors: | Stager Sheila V Calis Karim Grothe Dale Bloch Meir Berensen Nannette M Smith Paul J Braun Allen |
| Affiliation: | aVoice and Speech Section, NIDCD, Building 10, Room 5D-38, 10 Center Drive MSC 1416, Bethesda, MD 20892-1416, USA bPharmacy Department, Magnuson Clinical Center, Building 10, Room 1S-259, 10 Center Drive MSC 1196, Bethesda, MD 20892-1196, USA cBehavioral Psychiatry Branch, NIMH, Building 10, Room 3N-238, 10 Center Drive MSC 1272, Bethesda, MD 20892-1272, USA dStatistics Program, Department of Mathematics, University of Maryland, Room 4404, Mathematics Building, College Park, MD 20742, USA eLanguage Section, NIDCD, Building 10, Room 5N-118A, 10 Center Drive MSC 1407, Bethesda, MD 20892-1407, USA |
| Abstract: | Medications with dopamine antagonist properties, such as haloperidol, and those with serotonin reuptake inhibitor properties, such as clomipramine, have been shown to improve fluency. To examine the degree to which each of these two pharmacological mechanisms might independently affect fluency, a selective serotonin reuptake inhibitor, paroxetine, and a selective dopamine (D-2) antagonist, pimozide, were evaluated. Both types of medications also affect mood and anxiety, factors that could influence fluency levels. Therefore, we also evaluated the medications’ effects on generalized and speech-related anxiety and the relationships between changes in anxiety and changes in fluency in 11 subjects with a history of developmental stuttering. The randomized, double blind, placebo-controlled crossover study that was designed had to be terminated prior to completion due to severe side effects following withdrawal from paroxetine. Even with a reduced sample size (n = 6), significant improvement in percent fluent speaking time (p = 0.02) was found using a telephone task between baseline and pimozide (n = 6), with average duration of dysfluencies significantly shorter (p = 0.04) but no significant difference in the estimated number of dysfluencies per minute. This significant improvement was associated with non-significant increases in generalized anxiety, but non-significant decreases in speech-related anxiety. No significant differences were found in fluency between baseline and paroxetine (n = 5). These preliminary results suggest that fluency improvement is more likely to be mediated by dopaminergic rather than serotonergic mechanisms. Due to its side effects, however, pimozide may be considered a risk for treatment of stuttering. Educational objectives: As a result of reading this paper the reader will describe and explain: (1) how medications may affect fluency and the rationale for selecting medications for treatment trials; (2) the interrelationship between fluency and anxiety; and (3) factors important in developing clinical trials using medications. |
| Keywords: | Stuttering Dopaminergic Serotonergic Anxiety Fluency |
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