title: Treatment with medications affecting dopaminergic and serotonergic mechanisms: effects on fluency and anxiety in persons who stutter.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Voice and Speech Section, NIDCD, Bethesda, MD 20892-1416, USA. sstager@mfa.gwu.edu
authors.forename: Sheila V
authors.initials: SV
authors.lastname: Stager
authors.forename: Karim
authors.initials: K
authors.lastname: Calis
authors.forename: Dale
authors.initials: D
authors.lastname: Grothe
authors.forename: Meir
authors.initials: M
authors.lastname: Bloch
authors.forename: Nannette M
authors.initials: NM
authors.lastname: Berensen
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Smith
authors.forename: Allen
authors.initials: A
authors.lastname: Braun
mesh_terms: D000328:Adult; D001007:Anxiety; D018592:Cross-Over Studies; D018492:Dopamine Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D010868:Pimozide / Q000494:pharmacology / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D013342:Stuttering / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D013375:Substance Withdrawal Syndrome; D016896:Treatment Outcome; D014705:Verbal Behavior / Q000187:drug effects*
chemical_list: D018492:Dopamine Antagonists; D017374:Paroxetine; D010868:Pimozide; D017367:Selective Serotonin Reuptake Inhibitors