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Letters to the Editor   |    
Asenapine for the Treatment of Stuttering: An Analysis of Three Cases
Gerald A. Maguire, M.D.; David L. Franklin, Psy.D.; Jonathan Kirsten, M.D.
Am J Psychiatry 2011;168:651-652. doi:10.1176/appi.ajp.2011.10121729
View Author and Article Information
Orange, Calif.

Dr. Maguire has received research grants from Eli Lilly, Endo, Merck, and Otsuka; is on the speakers bureau for Angelini/Labopharm, Eli Lilly, Lundbeck, Merck, Novartis, and Sunovion; and is a consultant for Eli Lilly, Endo, Merck, and Teva. Dr. Franklin is a principal investigator for Abbott, Novartis, Otsuka, and Sepracor. Dr. Kirsten reports no financial relationships with commercial interests.

Accepted for publication in April 2011.

Accepted April , 2011.

Copyright © American Psychiatric Association

To the Editor: Stuttering is a disturbance in the fluency and time patterning of speech that affects 1% of the total population (1) and may be related to excess dopamine activity (2). Dopamine antagonist antipsychotic medications have been shown to be beneficial for the treatment of stuttering (3); however, a major side effect of many agents in this class is metabolic syndrome with associated weight gain (4). Asena-pine is a new atypical antipsychotic associated with less weight gain than other atypical antipsychotic medications (5). We report three cases of adults with stuttering who responded well to asenapine with good tolerability.

"Mr. M" is a 20-year-old man with moderate stuttering. At a treatment dosage of 5 mg of asenapine per day, the patient had a 60% improvement in his fluency as assessed by the Clinical Global Impressions (CGI-I) improvement subscale (6). After 5 months, the patient gained approximately 10 lbs and experienced mild sedation, but otherwise he tolerated the medication well.

"Mr. D" is a 45-year-old man with moderate stuttering. At a treatment dosage of 5 mg of asenapine per day, he experienced a 60% improvement in speech (much improvement on the CGI-I). While taking the medication, the patient noted increased irritability and sedation. He experienced no weight gain or appetite increase.

"Mr. A" is a 19-year-old man with moderate stuttering since he was 3 years old. At a treatment dosage of 10 mg of asenapine per day, his fluency increased approximately 75% (much improvement on the CGI-I). The patient tolerated asenapine well.

In each of these cases, 5—10 mg/day of asenapine was associated with improved fluency. The most common side effect was sedation. One patient reported a 10-lb weight increase, but the other two experienced none. All patients presented to our clinic for stuttering treatment, and no formal measures of fluency were taken. These case reports suggest that asena-pine may be an effective and well-tolerated medication for the treatment of stuttering. However, research using randomized placebo-controlled trials is warranted to further investigate asenapine in stuttering.

Craig  A;  Hancock  K;  Tran  Y;  Craig  M:  Epidemiology of stuttering in the community across the entire life span.  J Speech Lang Hear Res 2002; 45:1097—1105
[CrossRef] | [PubMed]
 
Wu  JC;  Maguire  G;  Riley  G;  Fallon  J;  LaCasse  L;  Chin  S;  Klein  E;  Tang  C;  Cadwell  S;  Lottenberg  S:  A positron emission tomography [18F]deoxyglucose study of developmental stuttering.  Neuroreport 1995; 6:501—505
[CrossRef] | [PubMed]
 
Maguire  GA;  Yu  BP;  Franklin  DL;  Riley  GD:  Alleviating stuttering with pharmacological interventions.  Expert Opin Pharmacother 2004; 5:1565—1571
[CrossRef] | [PubMed]
 
Allison  DB;  Mentore  JL;  Heo  M;  Chandler  LP;  Cappelleri  JC;  Infante  MC;  Weiden  PJ:  Antipsychotic-induced weight gain: a comprehensive research synthesis.  Am J Psychiatry 1999; 156:1686—1696
[PubMed]
 
Schoemaker  J;  Naber  D;  Vrijland  P;  Panagides  J;  Emsley  R:  Long-term assessment of asenapine vs olanzapine in patients with schizophrenia or schizoaffective disorder.  Pharmacopsychiatry 2010; 43:138—146
[CrossRef] | [PubMed]
 
Guy  W (ed):  ECDEU Assessment Manual for Psychopharmacology: Publication ADM 76-338 .  Washington, DC,  US Department of Health, Education, and Welfare, 1976, pp 218—222
 
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References

Craig  A;  Hancock  K;  Tran  Y;  Craig  M:  Epidemiology of stuttering in the community across the entire life span.  J Speech Lang Hear Res 2002; 45:1097—1105
[CrossRef] | [PubMed]
 
Wu  JC;  Maguire  G;  Riley  G;  Fallon  J;  LaCasse  L;  Chin  S;  Klein  E;  Tang  C;  Cadwell  S;  Lottenberg  S:  A positron emission tomography [18F]deoxyglucose study of developmental stuttering.  Neuroreport 1995; 6:501—505
[CrossRef] | [PubMed]
 
Maguire  GA;  Yu  BP;  Franklin  DL;  Riley  GD:  Alleviating stuttering with pharmacological interventions.  Expert Opin Pharmacother 2004; 5:1565—1571
[CrossRef] | [PubMed]
 
Allison  DB;  Mentore  JL;  Heo  M;  Chandler  LP;  Cappelleri  JC;  Infante  MC;  Weiden  PJ:  Antipsychotic-induced weight gain: a comprehensive research synthesis.  Am J Psychiatry 1999; 156:1686—1696
[PubMed]
 
Schoemaker  J;  Naber  D;  Vrijland  P;  Panagides  J;  Emsley  R:  Long-term assessment of asenapine vs olanzapine in patients with schizophrenia or schizoaffective disorder.  Pharmacopsychiatry 2010; 43:138—146
[CrossRef] | [PubMed]
 
Guy  W (ed):  ECDEU Assessment Manual for Psychopharmacology: Publication ADM 76-338 .  Washington, DC,  US Department of Health, Education, and Welfare, 1976, pp 218—222
 
References Container
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