<p>The first line treatment for stuttering (I'm a stutterer myself) is speech therapy. Such therapies generally focus on helping stutterers to learn ways to minimize stuttering when they speak, such as by speaking more slowly, regulating their breathing, or gradually progressing from single-syllable responses to longer words and more complex sentences. Most of these therapies also help address the anxiety a person who stutters may feel in certain speaking situations (source: <a href="https://www.nidcd.nih.gov/health/stuttering#treated" rel="nofollow noreferrer">NIH</a>). Anxiety management has especially worked well for me.</p>

<p>No drug therapy is currently approved against stuttering. I also don't know of any drug that targets the sympathetic nervous system. Having said that, there are a few interesting drugs investigated in clinical trials so far:</p>

<ul>
<li>Dopamine-blocking medications against bipolar disorder, Tourette’s Disorder and Schizophrenia have been found to be effective in reducing the symptoms of stuttering (source: <a href="https://westutter.org/what-is-stuttering/resources/pharmaceuticals-for-stuttering/" rel="nofollow noreferrer">NSA</a>). Their side effects, however, don't seem to weigh up against their effectiveness.</li>
<li><strong><a href="https://en.wikipedia.org/wiki/Pagoclone" rel="nofollow noreferrer">Pagoclone</a></strong>, a GABA-agonist used as anxiolytic has shown some effectiveness, but not enough to warrant it to be marked as anti-stutter therapy (source: <a href="https://www.stammering.org/speaking-out/article/pagoclone-disappointing-news" rel="nofollow noreferrer">BSA</a>)</li>
</ul>

CC BY-SA 4.0
2018-07-04T12:50:58.697Z
2018-07-04T12:58:55.590Z
2018-07-04T12:58:55.590Z
AliceD
<p>I am quoting a good overview from a Quora member about the reasons why people stutter when exposed to stress:</p>
<blockquote>
<p>...The underlying physiological basis of why stress provokes stuttering
has been addressed by <a href="https://jslhr.pubs.asha.org/article.aspx?articleid=1778933" rel="noreferrer">Weber &amp; Smith, (1990)</a>. It shows that speaking
increases autonomic activity (elevated blood flow, increased heart
rate, sweating) and that this sympathetic arousal was correlated with
increased stuttering behaviors in stutterers. Interestingly, the
sympathetic arousal of stutterers was found not to be outside the
range of controls. The authors bring up several hypotheses as to why
sympathetic activity may deteriorate speech fluency in stutterers:</p>
<p>Increased autonomic activity has been associated with <strong>irregular
breathing</strong>, which may affect speaking;</p>
<p>Release of the <strong>stress hormone adrenalin</strong> may induce <strong>muscle tremor</strong> and <strong>spasms</strong> that can affect speech production;</p>
<p>Sympathetic regulation of <strong>afferent control of the
sensitivity of sensory receptors</strong> (muscle spindles and
mechanoreceptors) in the <strong>oralmotor, laryngeal and respiratory system</strong>
may affect speech motor processes;</p>
<p>The <strong>gain of reflex arches</strong>
(feedback) involved in the <strong>musculature engaged in speech</strong> may be
modulated such that speech fluency is negatively impacted.</p>
</blockquote>
<p>Unfortunately, clinical research in this field is not that advanced and good evidence on human studies is yet to be seen.</p>
<p>My question is whether we already know compounds whose mechanisms can <strong>in theory</strong> help to deal or ameliorate these pathological process in stutterers?</p>

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2018-01-13T21:24:19.797Z
Looking at https://www.mnsu.edu/comdis/kuster/journal/osborne5/drugs.ppt which mentions benzos and atypcal antipshychotics, it seems the drug effect is rather non-specifc and perhaps mediated by sedation. I'm surprised nobody tried valproate or some other anti-epileptic for the same reason.
got trolled too much this week
CC BY-SA 3.0
2018-01-13T21:26:02.277Z
Oh, they did try https://doi.org/10.1016/S1388-2457(10)61038-3
got trolled too much this week
CC BY-SA 3.0
2018-01-13T21:38:49.633Z
But those are mostly open-label and even weaker studies (single case reports etc.) Of the systematic ones, not much works https://www.ncbi.nlm.nih.gov/pubmed/22020347
got trolled too much this week
CC BY-SA 3.0
2018-01-13T21:42:10.587Z
Also https://www.asha.org/Events/convention/handouts/2009/1629_Maguire_Gerald/
 mentions that botulinum toxin injections in the larynx were tried, without success, so that make me doubt the muscle-based theories...
got trolled too much this week
CC BY-SA 3.0
2018-01-13T21:57:27.040Z
But the actual study says something fairly different. https://www.ncbi.nlm.nih.gov/pubmed/7991110 Spin doctors.
got trolled too much this week
CC BY-SA 3.0
2018-01-14T05:26:54.717Z
It seems to me that the research is very broad at the moment but with no actual causal evidence demonstrating direct, consistent, and sustained influence on stuttering. I would think that the connecting factor would be vagus nerve as it innervates the larynx muscles but is also involved in the sympathetic/parasympathetic regulation? I have not seen research on vagus nerve interventions and its relation to stuttering.
Sandra
<psychopharmacology><stress><anxiety><speech><pathology>
How to counteract the deterioration of speech in stutterers by targeting sympathetic arousal?
Sandra
# How to counteract the deterioration of speech in stutterers by targeting sympathetic arousal?

(Asked by: username_0 on 2018-01-13)

I am quoting a good overview from a Quora member about the reasons why people stutter when exposed to stress:

> ...The underlying physiological basis of why stress provokes stuttering
> has been addressed by [Weber & Smith, (1990)](https://jslhr.pubs.asha.org/article.aspx?articleid=1778933). It shows that speaking
> increases autonomic activity (elevated blood flow, increased heart
> rate, sweating) and that this sympathetic arousal was correlated with
> increased stuttering behaviors in stutterers. Interestingly, the
> sympathetic arousal of stutterers was found not to be outside the
> range of controls. The authors bring up several hypotheses as to why
> sympathetic activity may deteriorate speech fluency in stutterers:
>
> Increased autonomic activity has been associated with **irregular
> breathing**, which may affect speaking;
>
> Release of the **stress hormone adrenalin** may induce **muscle tremor** and **spasms** that can affect speech production;
>
> Sympathetic regulation of **afferent control of the
> sensitivity of sensory receptors** (muscle spindles and
> mechanoreceptors) in the **oralmotor, laryngeal and respiratory system**
> may affect speech motor processes;
>
> The **gain of reflex arches**
> (feedback) involved in the **musculature engaged in speech** may be
> modulated such that speech fluency is negatively impacted.

Unfortunately, clinical research in this field is not that advanced and good evidence on human studies is yet to be seen.

My question is whether we already know compounds whose mechanisms can **in theory** help to deal or ameliorate these pathological process in stutterers?

**Tags:** psychopharmacology, stress, anxiety, speech, pathology

> **Comments:**
> **username_1**: Looking at https://www.mnsu.edu/comdis/kuster/journal/osborne5/drugs.ppt which mentions benzos and atypcal antipshychotics, it seems the drug effect is rather non-specifc and perhaps mediated by sedation. I'm surprised nobody tried valproate or some other anti-epileptic for the same reason.  
> **username_1**: Oh, they did try https://doi.org/10.1016/S1388-2457(10)61038-3  
> **username_1**: But those are mostly open-label and even weaker studies (single case reports etc.) Of the systematic ones, not much works https://www.ncbi.nlm.nih.gov/pubmed/22020347  
> **username_1**: Also https://www.asha.org/Events/convention/handouts/2009/1629_Maguire_Gerald/  mentions that botulinum toxin injections in the larynx were tried, without success, so that make me doubt the muscle-based theories...  
> **username_1**: But the actual study says something fairly different. https://www.ncbi.nlm.nih.gov/pubmed/7991110 Spin doctors.  
> **username_0**: It seems to me that the research is very broad at the moment but with no actual causal evidence demonstrating direct, consistent, and sustained influence on stuttering. I would think that the connecting factor would be vagus nerve as it innervates the larynx muscles but is also involved in the sympathetic/parasympathetic regulation? I have not seen research on vagus nerve interventions and its relation to stuttering.  

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## 1 answers

### Answer by username_2 on 2018-07-04. Score: 3

The first line treatment for stuttering (I'm a stutterer myself) is speech therapy. Such therapies generally focus on helping stutterers to learn ways to minimize stuttering when they speak, such as by speaking more slowly, regulating their breathing, or gradually progressing from single-syllable responses to longer words and more complex sentences. Most of these therapies also help address the anxiety a person who stutters may feel in certain speaking situations (source: [NIH](https://www.nidcd.nih.gov/health/stuttering#treated)). Anxiety management has especially worked well for me.

No drug therapy is currently approved against stuttering. I also don't know of any drug that targets the sympathetic nervous system. Having said that, there are a few interesting drugs investigated in clinical trials so far:

* Dopamine-blocking medications against bipolar disorder, Tourette’s Disorder and Schizophrenia have been found to be effective in reducing the symptoms of stuttering (source: [NSA](https://westutter.org/what-is-stuttering/resources/pharmaceuticals-for-stuttering/)). Their side effects, however, don't seem to weigh up against their effectiveness.
* **[Pagoclone](https://en.wikipedia.org/wiki/Pagoclone)**, a GABA-agonist used as anxiolytic has shown some effectiveness, but not enough to warrant it to be marked as anti-stutter therapy (source: [BSA](https://www.stammering.org/speaking-out/article/pagoclone-disappointing-news))


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