Medications for Stuttering
- Vitamin B-1 (Thiamin)
- Prescription Medications That Reduce Stuttering
- Prescription Medications That Increase Stuttering
- Other Medications
Vitamin B-1 (Thiamin)
In a study published in 1951 in the Journal of Speech and Hearing Disorders [1], an unspecified number of preschool stutterers were divided into two groups. One group received 30 mg thiamin (vitamin B-1) daily; the other received a placebo. After one month the groups were reversed. The study was double-blind. The results were observable "speech improvement" in 55% of the children when receiving the vitamin, possible speech improvement in 20% of the children, and no improvement in 20% of the children. Dividing the children by age,
- Of the two- and three-year olds, 80% had observable improvement.
- Of the four-year-olds, 50% had observable improvement.
- Of the five-year-olds, improvement was "doubtful."
- Of the seven- and eight-year-olds, no improvement was seen.
Furthermore, four children who'd received vitamin B-1 during the first month had increased stuttering the second month, when they received the placebo. A fifth child who was reported as not improved the first month, with the vitamin, had increased stuttering the second month, with the placebo.
All improvements were seen within two weeks of taking vitamin B-1.
The study refers to a masters thesis in which 17 adults who stutter receiving stuttering therapy were given vitamin B-1 or a placebo, and then the groups were reversed. The results were that "the greatest speech improvement was observed during the periods of thiamin consumption."
I'd never heard of this study until six months ago, when Martin Schwartz, Ph.D., who is Executive Director of the National Center for Stuttering, told me that he'd repeated the study. [2] He divided 38 adult male stutterers into two groups. One group received 300 milligrams of vitamin B-1 and the other received a placebo. The study was double-blind. The study lasted two weeks. Using a standardized test for stuttering, no statistically difference was found between the two groups at beginning of the study. No difference was found in the placebo group between the beginning and the end of the study.
Of the 19 men who received the vitamin, stuttering was "largely eliminated" in six of the men. For the other 13 men no effect was seen. The six men were then followed for seven months and "their speech has remained essentially free of stuttering." In other words, vitamin B-1 appears to be an effective treatment for about 30% of adult male stutterers.
I went to a vitamin store and bought a bottle of 300 mg B-1. Within days my speech was much better. I still had some mild disfluencies but my fluency was better than almost any period in my life. I did no speech therapy or anything else to improve my fluency. Two months later my speech deteriorated. It wasn't quite as bad as before taking vitamin B-1 but it wasn't much better. A week later I remembered that I'd finished the first bottle and had bought a new bottle. I read the label and found that I'd grabbed a 100 mg dosage bottle. I then went back to 300 mg and my fluency returned within a few days. That was about a month ago and my fluency continues.
The Recommended Daily Allowance (RDA) of vitamin B-1 is 1.4 mg, i.e., the minimum amount needed for health. No Tolerable Upper Intake Level (UL) is specified, i.e., there doesn't appear to be any level that is toxic. Foods that are rich in vitamin B-1 include yeast, pork, whole wheat flour, oatmeal, flax, sunflower seeds, brown rice, whole grain rye, asparagus, kale, cauliflower, potatoes, oranges, liver (beef, pork and chicken), and eggs. Antagonists (foods to avoid) include sulfite preservatives, which are commonly added to wine, dried fruit, and dried potato products. Also to be avoided are and raw fish and shellfish, especially shrimp. [3]
Dr. Schwartz recommends taking 300 mg daily, as three 100 mg pills taken one at each meal. He also recommends taking 400 mg of magnesium orotate daily, as two 200 mg pills, one at breakfast and one at dinner. I've been taking the magnesium for over a month and haven't seen any change in my speech, but I've also heard that magnesium can take months to be absorbed into one's cells. Dr. Schwartz also advises no coffee, tea, carbonated beverages, meat, chicken, raw fish (sushi), antacids, or alcohol; and recommends taking a teaspoon of lemon juice in a glass of spring water four times a day (upon rising and before sleeping and between meals).
Prescription Medications That Reduce Stuttering
A journal article reviewed 31 studies of 19 pharmacological treatments for stuttering published between 1970 and 2005. [4] The review criticized all 31 studies for not testing stuttering outside of speech clinics, i.e., in situations of daily living, and for not measuring speaking rate or speech naturalness.
A second journal article reviewed seven studies of pharmacological treatments for childhood stuttering (subjects under 18 years old). Only one study was found with strong study design (i.e., the study met seven scientific standards), and this study found that clonidine did not reduce stuttering. The other six studies did not meet the scientific standards. These studies investigated risperidone, olanzapine, clonidine, tiapride, haloperidol, and chlorpromazine. [9]
Haloperidol
Haloperidol (Haldol) is a dopamine antagonist (blocks D2 receptors). It is widely used to treat Tourette syndrome and schizophrenia. Ten studies of haloperidol have been done with stutterers; of these, five studies were considered of sufficient trial quality (i.e., the studies were done scientifically) to be reviewed. Haloperidol was ineffective in four of the five studies; one study found more than a 50% reduction in stuttering.
The side effects of haloperidol can be severe, including tardive dyskinesia.
Risperidone
Risperidone (Risperdal) is a dopamine antagonist (blocks D2 receptors). It is FDA-approved for treating manic bipolar disorder and schizophrenia. A study with 16 adult stutterers over six weeks found that stuttered syllables decreased 51% in the subjects taking the medication, and 27% for the subjects taking a placebo. [5] Side effects include weight gain. Many other side effects are listed for risperidone, but the side effects are usually much less severe than with haloperidol.
Olanzapine
Olanzapine (Zyprexa) blocks serotonin and dopamine receptors. It is FDA-approved for the treatment of schizophrenia and bipolar disorder. A study with 24 adult stutterers over twelve weeks found that stuttered syllables decreased 33% in the subjects taking the medication, and 14% for the subjects taking a placebo. [6] Subjects averaged eight pounds of weight gain. (One of the researchers took the medication for ten years and gained 20 pounds.) Many other side effects are listed for risperidone, but the side effects are usually much less severe than with haloperidol.
Pagoclone
Pagoclone is a GABA agonist. It is not FDA-approved for any disorder. 132 stutterers were given either pagoclone or a placebo for eight weeks. Those who received pagoclone had an average 19.4% reduction stuttering, compared with 5.1% reduction for those who received the placebo. 55% of the subjects taking pagoclone had improved speech, compared to 36% of the subjects taking the placebo. Some of the subjects then continued using pagoclone, with a 40% reduction stuttering after 1 year. Stuttering was only assessed in a clinical setting. Side effects were minimal, with 12.5% of pagoclone patients reporting headaches. [7] Endo, the manufacturer of Pagoclone, stopped clinical trials with stutterers, apparently because the Phase II trials didn't go well.
Prescription Medications That Increase Stuttering
Many medications make stuttering worse. Some even cause stuttering. No research has been done on this important subject, but the following anecdotal reports may help you or your child to avoid certain medications.
Methylphenidate
Methylphenidate (Ritalin) increases the levels of dopamine and norepinephrine in the brain through reuptake inhibition of the monoamine transporters. It is a dopamine agonist, the opposite of the above medications (haloperidol, risperidone, olanzapine) that reduce stuttering.
A speech-language pathologist asked on an Internet forum:
I'm treating an 8-year-old diagnosed ADHD and who suddenly began stuttering (advanced core and secondary behaviors) without any prior history of disfluency, as a side effect of the medication Ritalin. He's had a whole neuro work-up which revealed nothing.
Another speech-language pathologist responded that many of the children he treated for stuttering were on Ritalin for ADHD.
Pharmacist and stutterer 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.
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 hire Richard Harkness ( This email address is being protected from spambots. You need JavaScript enabled to view it. ) for a consultation.
SSRI Anti-Depressants
A study of the selective serotonin reuptake inhibitor (SSRI) paroxetine (Paxil) on stutterers was terminated due to severe side effects. [8]
SSRI medications can increase stuttering in stutterers, apparently by boosting dopamine. In a few cases, these drugs caused non-stutterers to stutter. Stutterers taking SSRI anti-depressants report feeling less depression, but their increased stuttering makes them feel worse:
I was sitting in the hallway, in the dark. I had been crying and hitting my head on the wall, screaming to God, why me? I hated my stuttering and I suppose hated myself as well. From that point on it was as if when I remembered that incident all the feelings came back to me and wouldn’t leave. Those angry, hurt, frustrating feelings from so long ago wouldn’t go away. I was hiding my feelings from everyone around me, pretending to be super mom and super wife. I decided to seek professional help.
We decided that I would try Wellbutrin [bupropion, a norepinephrine and dopamine reuptake inhibitor]. As my doctor put it, kill two birds with one stone, since Wellbutrin is also prescribed to help you quit smoking. The first week I felt like I had so much anxiety that I could explode. The second week I noticed my stuttering getting worse. By the third week the controls that I had learned in speech therapy were virtually unusable. It was so frustrating to not be able to control my stuttering at all. Needless to say we all agreed to flush the Wellbutrin and never go back on anything like that. Prozac, Trazadone and Effexor did not effect my speech at all.
Another stutterer wrote:
I have tried 3 antidepressants: Prozac, Wellbutrin, and Zoloft. All increased my stuttering noticeably. The anti-depressants 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 went in to 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.
Other Medications
Botulinum Toxin
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.
Alcohol
No researchers have investigated the effects of alcohol on stuttering. (Finding volunteers wouldn’t be a problem at most universities!)
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, and so increases stuttering.
References
[1] Hale, L. (1951). A consideration of thiamin supplement in prevention of stuttering in preschool children. Journal of Speech and Hearing Disorders, 16:4; 327-333.
[2] Schwartz, M. (February 9, 2011). Breakthrough: a possible cure for stuttering. New York, NY (PRWEB)
[3] Thiamine, Wikipedia, accessed 2011 March 20.
[4] Bothe, A., Davidow, J., Bramlett, R., Franic, D., & Ingham, R. (2006). Stuttering treatment research 1970–2005: II. Systematic review incorporating trial quality assessment of pharmacological approaches. American Journal of Speech-Language Pathology, 15, 342-352; 1058-0360/06/1504-0342.
[5] Maguire, G., Riley, G., Franklin, D., Gottschalk, L. (2000). Risperidone for the treatment of stuttering. Journal of Clinical Psychopharmacology, 20, 479-482.
[6] Maguire, G. A., G. D. Riley, et al. (2004). Olanzapine in the treatment of developmental stuttering: a double-blind, placebo-controlled trial. Annals of clinical psychiatry, 16(2): 63-67.
[7] Maguire, Gerald; Franklin, David; Vatakis, Nick G.; Morgenshtern, Elena; Denko, Timothey; Yaruss, J. Scott; Spotts, Crystal; Davis, Larry; Davis, Aaron; Fox, Peter; Soni, Poonam; Blomgren, Michael; Silverman, Andrew; Riley, Glyndon. (2010) Exploratory Randomized Clinical Study of Pagoclone in Persistent Developmental Stuttering. Journal of Clinical Psychopharmacology: February 2010 - Volume 30 - Issue 1 - pp 48-56 doi: 10.1097/JCP.0b013e3181caebbe
[8] Stager, S., Calis, K., Grothe, D., Bloch, M., Berensen, N., Smith, P., & Braun, A. (2005). Treatment with medications affecting dopaminergic and serotonergic mechanisms: Effects on fluency and anxiety in persons who stutter. Journal of Fluency Disorders, 30:4, 319-335.
[9] Boyd A, Dworzynski K, & Howell P. (2011). Pharmacological Agents for Developmental Stuttering in Children and Adolescents: A Systematic Review. J Clin Psychopharmacology, 2011 Oct 20, PMID: 22020347.
