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From: Nathan E. Lavid, MD
Date: 13 Oct 2009
Time: 13:39:56 -0500
Remote Name: 75.142.104.151
I apologize for not responding to your question earlier. Regarding the association of stuttering and medications for asthma/allergies, the association relies on the mechanism of action of the medication. For example, an antihistamine, such as Benadryl, has no potential to disrupt fluency as the mechanism is inhibiting the process of inflammation by modulating the actions of a specific white blood cell. Inflammation has no effect on fluency. Whereas, the use a stimulant mediation, such Sudafed, is effective by inducing constriction of blood vessels to alleviate congestion. A potential side effect of this stimulation is anxiety, which and exacerbate stuttering by this secondary means and, rarely, a primary exacerbation of stuttering, where the mechanism is not well understood, but probably by a mechanism similar to the exacerbation of tics found with Sudafed. As for the use of medications in adolescents with anxiety, the medications of choice, the selective serotonin reuptake inhibitors (SSRIs) have a number of potential adverse effects and carry a black box warning from the FDA regarding these risks. The mediations are not dispensed cavalierly to patients as a whole and require a face-to-face evaluation and assessment that includes a physical work-up. If these medications are being considered, a referral to a psychiatrist or pediatrician comfortable prescribing psychotropic medication is appropriate.