Stuttering Cases of succesfully treated with drug therapy
ZNALI
stuttering
A-Cases directly under supervision of Dr.Brady
CASE # 1A
The first, patient "A", is a 36 year old man who has stuttered since age 5. He
has had limited success with a variety of treatments over the years. Dr.Brady
treated him several years ago with a variety of pharmacologic agents, including
Aricept, bethanechol, verapamil and Risperdal. None was helpful. Dr.Brady
despaired of finding an effective drug regimen. Three months ago Dr.Brady saw
patient "A" again. His speech was the same - moderately severe stuttering. He
was started - a small dose of alprazolam (0.5 mg hs) with a small dose of
clomipramine (25 mg hs). Then dosages of both drugs were systematically
increased. When the dosage of alprazolam reached 2 mg hs and clomipramine
reached 100 mg hs, his "speech was dramatically improved. He estimated an 80%
reduction in stuttering. Dr.Brady was equally impressed on talking with him. He
reports speaking more at work and in social situations. The only side effects
he has are some fatigue and constipation. He continues to improve without
additional increases in medication. He started treatment on11/17/98 and since
then he is continuously on treatment under supervision of Dr.Brady. He tried
Celexa, another antidepressant drug, suggested by Dr.Brady but candidate was
more satisfied with combo of cloimipramine and Alprazolam so preferred using
latter.
CASE # 2A
The second patient, Mr. JD, is a 47 year old married man who has stuttered
since age 4. He has benefited from some speech therapy but still is a severe
stutterer. He was begun on clomipramine (25 mg hs). This brought some immediate
but modest improvement in speech. Hence Dr.Brady gradually increased the
dosage of alprazolam to 0.5 mg tid and clomipramine to 25 mg qid. At this
dosage level he reported marked improvement in speech and in his adjustment in
general but could not tolerate side effects so contained himself at lower
doses.He started treatment on 4/9/99 and still on it.He also tried Celexa for a
while but he preferred to switch back to combo of cloimipramine and Alprazolam.
CASE #3A
The third patient, Dr. AM is a 55 year old physician who has a severe
stuttering problem since age 4 He had tried numerous medications and therapy
programs over the years, but had obtained only minimal improvement in his
speech.. He started first with combo of cloimipramine and Alprazolam.He got
significant control over stuttering but he could not tolerate the side effects
of this combo.Dr.Brady suggested him to use Celexa.He tolerated this medication
with satisfied control of stuttering. He scored 6 (severe stutter) on the
7-point scale for rating the severity of stuttering. His response to the
combination of alprazolain (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 suttering, 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 bed- time).Dr.A reported he had used Prozac plus Xanax
before present therapy a while ago and that the regime aggravated his
stuttering instead of improving.Dr.A told Dr.Ali
on phone that he was 10-15% more fluent on combo of Alprazolam and
Cloimipramine as compared to using Celexa alone or with Alprazolam.But latter
is conferring him satisfactory and significant control of stuttering with
minimal side effects profile.
CASE # 4A
Fourth is "AA" ,52 years of age,male having initial stuttering rating scale of
6.He was put on celexa 20mg HS and xanax 0.5mg tid.He started treatment on
1/26/99.Until 4/22/99 his stuttering improved significantly with stuttering
rating csacle reduced to 1.5.
CASE # 5A
Female,"WJ",52 year old with initial stuttering rating scale of 3 was put on
Celexa 20mg OD and Xanax 0.5mg TID.She could not resisted drowsiness at work.
So Dr.Brady put her on Buspar 10mg HS in replace of Xanax while continuing
Celexa.She started therapy 9/10/99.By 10/4/99 her stuttering rating scale was
reduced to 1.
CASE # 6A
Female,"CB",39 years old with very severe and uncontrolled form of stuttering
had stuttering rating scale of 6.5 at start of treatment(5/10/99).She was put
on celexa 20 mg hs and Xanax 0.5 mg hs.She tried Cloimipramine plus Xanax in
place of celexa plus Xanax but tolerated medications very poorly so switched
back to to original regime.Her present stuttering rating scale is 4.5.She is
relatively tough case to treat.
CASE #7A
Female"EE",50 years old, with stuttering rating scale of 4 at start of
treatment(6/29/99) was given Xanax
0.5mg hs and Celexa 20 mg/day.By 11/55/99 her rating scale was reduced to 1.5.
B-Cases treated by their family physician based on information posted on
internet by Dr.Zahir Ali
Cases # 1B
(I am attaching email of patient's Father to me)
Date: 17.05.00 16:18:54 Eastern Daylight Time
My name is RC and I have had some contact with both(Dr.Ali and Dr.Brady) of you
regarding my 16 year old son who has stuttered since he was about three years
old.
He started the drug treatment (Alprazolam & Clomipramine) March 27, 2000. He
has been at full dose (alprazolam 1mg/day, clomipramine 100m/day) for several
weeks. We have seen drastic improvement in his fluency. He is very happy with
the transformation. He only occasionally has trouble, but reports even them he
has more control and just slows down and everything comes out right. He no
longer has big blocks. I would guess and say that he is about 90% fluent and
seems to improve a little every week.
The only side effect seems to be slight drowsiness......he says it doesn't
bother him and it seems to be lessening. He now goes out and socializes with
others his own age. He even has started to attend a youth group at church.
Something he would have never done. He was so excited that he can now even
order his own food in restaurants! He even speaks up during class at school.
He seems to have a whole new life!!
As I reported to Dr. Ali. My son also had almost daily migraines and they have
also subsided after starting the medicine.Thank you both so much for your help.
Dr. Brady, thank you for sending me a copy of the published article. I will
continue to report back our results. We were very fortunate to find a doctor
here that was willing to help us, Neurologist, Dr. PS - San Jose, Ca. Thanks
again!
CASE # 2B
(Direct email of patient to Dr.Ali)
(Date: 21.03.00 12:23:15 Eastern Standard Time)
It has now been two months since I started your treatment, and I have found it
has relieved my stutter by about 70-80%. This has indeed been greatly
beneficial to me, and has enabled me to speak far more effectively.I have been
posting messages of my case to the alt.support.stuttering newsgroup using a
deja account and my username of sb.My question now is, is there anything you
would like me to do that would aid the research and development of this
treatment? For example, I would be happy to compile a case study and send it
to you or Dr. Brady if it would help.If I can be of any assistance I will be.
Thank you very much for making this treatment known to me, I wish you all the
best and would be interested
in hearing of any further developments with this treatment.SB ,UK
Thirsk, UK
CASE # 3B
This message was posted on Stuttering Home Page
<http://www.mankato.msus.edu/dept/comdis/kuster/chat/chatroom.html>
John Smith - 02:54pm Mar 25, 1999 CST
I have been a stutter for over fifty years. In spite of this I have become a
competent professional. My stuttering had become worse over the last few years
and was severe. I took the combination of cloinipramine and alprazolam under
medical supervision with dramatic improvement in my fluency within 24 hours. I
tried stopping the medications and by the 5th and 6th days my fluency
deteriorated and stuttering returned. I resumed the medication and fluency
returned.On the medication I could realize how much tension had been in my
voice box and that it was relieved resulting in improved fluency.
CASE # 4B
Case A male in his twenties was with history of migraine headache and
stuttering for many years.He was taking Amitryptaline(Elavil) 50-75 mg/day
prescribed to control his migraine headache for last eleven years.During last
one year his physician added Klonopin to enhance anxiety control related to
stuttering.After a while his physician replaced klonopin with xanax.Within one
week of combined use of elavil and xanax he noticed dramatic improvement in
fluency and overall stuttering behavior.All previously feared speaking
situations were no more hindrance in speaking effectively and with enhanced
fluency control.When he read Dr.Ali posting about his drug treatment of
stuttering on internet he sent email to former.Dr.Ali informed him elavil was
very similar to cloimpramine in clinical action so his improvement in
stuttering was quite predictable on basis of Dr.Ali's hypothesis. Unfortunately
his physician was not willing to prescribe xanax for long period for potential
risk of addiction so he switched back him from xanax to Klonpin.He returned to
previous level of stuttering.Then patient was looking for another physician to
get prescription of xanax.
CASE # 5B
Date: 28.02.00 14:37:36 Eastern Standard Time
As I told you before the drugs have not cured my stutter , but I do feel much
more relaxed in myself and calmer. I do feel the drugs have improved my speech
but not total fluency yet . However the side affects i was experiencing are not
so bad at all now . I have been taking maximum dosage of both drugs now for
about 8 weeks . 100mg of clomipramine a day , and 100mcg of alprazolam a day .
I take the drugs all at the same time at nightime, should I take the doses in
stages throughout the day or is it ok to take them all at once.Anyway on the
whole , the drugs have improved my speech so I suppose any improvement is
better than nothing . Thankyou for keeping in touch , and please get back to me
as soon as possible.
CASE # 6B
This stutter got alprazplam prescription from his physician only after former
showed our article published in a medical Journal to latter.
Date: 11.05.00 03:22:51 Eastern Daylight Time
Ok, I have been on Alprazolam for 1 week (and still originally taking Zoloft
for about 1.5 months now). And I don't know whether or not it's the Zoloft's
effects that has finally "kicks" in, or it's the Alprazolam, but since I've
been taking Alprazolam, I could really see my speech is getting better.
Somehow, the anxiety of speaking is lessen in my mind. So I talk more
naturally and spontaneously. I could say words now that I had anxiety of
saying it before. And the anxiety effects of the Alprazolam don't just work on
my speech, but it works on my surrounding as well. I don't get humanphobia
like I used to before; I am less shy now. And I think all these factors
definitely contribute to my fluent speech. But I am not to a point of
satisfying with my speech. Despite all the positive signs of the last week, I
am still stutter noticeably.
Can I improve my speech by continue taking the same dosage of Alprazolam or
increase it?
Should I disconnect taking Zoloft and begin to take Cloimipramine
GROUP CASES (# 7B)
About 6 more cases started treatment and contacted me about their results.These
cases have common characteristics.All took Cloimipramine and Alprazolam in
gradually increasing doses for less than or equal to 4 weeks time.They
tolerated two side effects very poorly i.e. drowsiness and impotency.Even
most noticed very early improvement in stuttering control but they preferred
not to continue drug therapy in wake of side effects.
GROUP CASES(# 8B)
About six more cases could not start the treatment because their family
physician did not want to prescribe Alprazolam for long time because its
potential risk of addiction.
Conclusion
Alprazolam and Cloimipramine in combination is new effective drug treatment of
stuttering. Some patients tolerate side effects well and others not. Some
stutters noticed stuttering control within days and some take weeks. Some need
lower doses than other to bring same control over stuttering. Among tricyclic
antidepressant Cloimipramine seems to be standard but Elavil is also effective.
Among SSRI group Prozac seems to have no antistuttering action as noticed by
Dr.Ali in his own case and in case #3C.Dr.Ali never
received any claim that Prozac helped any body in controlling stuttering.But
some other SSRI like Zoloft,Paxil and Celexa are effective in controlling
stuttering either as single agent or in combination of Xanax or Buspar in
selected cases. Specially Dr.Brady has found encouraging results with
celexa.Klonopin in compare to Xanax also does not seem to have antistuttering
action.
Depending on the tolerance to side effects of medications, someone can try one
of following drugs regime as treatment of stuttering
1)Cloimipramine plus Alprazolam
2)Celexa plus alprazolam
3)Celexa plus Buspar
4)Celexa alone.
mike jones
seemed to fade. Is it possible to build a tolerance to Xanax? Also
has Busar been effective as a replacement for Xanax?
Mike
User8747869
but I have yet to find a doctor willing to prescribe benzodiazepines long-term
and to try different ones to see which is most compatible with me.
I have only a little experience taking klonopin, and so far my perception is
that it improves my fluency almost 100%, if not 100%. I just need to get more
experience using it to find its effects. One of my problems is finding a
doctor in my area who isn't benzophobic. I live in san jose, if anyone knows a
doctor the 408 or 650 area that is good please refer me.
About xanax, I'm interested in trying that too. I've read peoples stories on
other boards(the anxiety and social phobia boards) where they've used it for
years and it hasn't lost its effects. Buspar didn't do anything for me except
side effects. I searched usenet and it seems it doesn't work for that many
people either.
The only negative thing about klnopin that I noticed so far in my very limited
use is that it makes it harder for me to study and read, it gives me minor
impairment, but I already have ADD/ADHD so maybe for a person without that it
would not be as bad. So I'm trying to medication for that too and stuttering
and other things like anxiety.
mike jones
one may be more safe. I'm taking .25 mg twice a day. I was taking .5
mg and i see no difference in my stuttering between the two amounts.
The only side effects is that I'm a little more tired. I would say
it helps my speech between 70-80 percent. I'm also taking
Clomipramine.
mike
