Alprazolam, Citalopram, and
 Clomipramine for Stuttering

John Paul Brady, M.D. Zahir Ali, M.D.
Merion, Pennsylvania Elmhurst, New York

Stuttering is known to be a developmental disorder, with many experts agreeing on a strong neurological component. In an adult, stuttering is noted as speech behaviors such as repetitions and prolongations, often accompanied by great anxiety as he/she anticipates a speaking situation. This anxiety can make the speech behaviors worse, with some severe stutterers experiencing speech blocks and tremors of the lips and jaw, rapid eye blinking, and other body movements in their efforts to get their words out. Anticipating such struggle to talk often leads to more anxiety in future speaking situations and so the stuttering and the anxiety feed each other.

A number of drugs have been reported to reduce stuttering. (1,2) One of these drugs is alprazolam (Xanax), an antianxiety agent. Included also are citalopram (Celexa), a selective serotonin reuptake inhibitor, and clomipramine (Anafranil), another strongly serotonergic drug. All three of three of these agents reduce stuttering in selective patients. However, only a minority of patients who stutter respond with increased fluency to any of these drugs. Those who do respond usually show only a very modest reduction in stuttering. We believe that adults with severe stuttering may require two medications, one directed at each component of the disorder.

To test this hypothesis, we undertook the treatment of Dr. A., a 57-year-old physician with a severe stutter since age 4 years. He scored 6 (severe stutter) on the 7-point scale for rating the severity of stuttering. (3) He had tried numerous medications and therapy programs over the years, but had obtained only minimal improvement in his speech. His response to the combination of alprazolam (1.0 mg twice daily) and citalopram (10 mg at bedtime) was prompt and dramatic. We could detect only traces of his former impediment. Family, friends, and colleagues have all spontaneously noted and remarked on his greatly increased fluency. Dr. A. reports that he now speaks out in many situations where previously he said little out of fear of stuttering. His score on the Stuttering Rating Scale decreased from 6 to 2 (mild stutter). In his 20th week of treatment, Dr. A. continued to improve. With this great reduction in stuttering, his anticipatory anxiety has greatly reduced, making it possible to gradually discontinue his alprozolam use. However, the citalopram (reducing the core symptoms of stuttering) remains necessary (20 mg at bedtime).

We have treated three additional men with severe stuttering in this manner. Two reported experiencing fewer side effects with clomipramine (100 mg at bedtime) and will continue with this agent. The third patient reported fewer side effects with citalopram (20 mg at bedtime) and will continue with this drug. All three showed marked improvement in their speech on the Stuttering Rating Scale (from 6-6.5 before treatment to 1.5-2 with treatment). All three continue to take alprazolam as well (1 mg twice daily).

References:

1. Brady JP. The pharmacology of stuttering: a critical review. Am J Psychiatry 1991;1448: pages 1309-16.
2. Brady JP, Rynn M. Stuttering: current pharmacological options. CNS Drugs 1994;1: 261-268.
3. Johnson W., Darley F.L., Spriesterback D.C. Scale for rating severity of stuttering.In: Diagnostic methods in speech pathology. New York: Harper and Row, 1963.