Friday, August 24, 2007

I am studying Neuropharmacology

I have decided to learn more about neuropharmacology, and bought the text book The Biochemical Basis of Neuropharmacology by Cooper et al.

Several of my readers are more knowledgeable about stuttering medication, neurotransmitters, and so on. This needs to stop! :-) In a few weeks, I'll be able to make more informed comments.

My current view on neuropharmacology and stuttering is that it might very well help people who stutter but is no cure. The brain chemicals modulate the activity of different brain systems, a bit like different weather impacts a big city in different ways. Dry weather makes traffic jams on highways less likely, but construction work or rush hour still leads to traffic jams, but less severe ones.


willme said...

Good choice, Tom. Will be looking forward to it. I've been dabbling in the neurochemistry literature myself and also have a lot to learn. Giving simple explanations that a lay-person can understand will be useful.
In addition, I've started a program of experimenting with different (legal) drugs. I'm currently trying Celexa (Citalopram) since J.P. Brady suggested that it worked with a few of his patients--the jury is still out on this "trial." The idea behind this drug experimentation is that scientific research consists of two activities--induction and deduction. Induction moves from specific instances to generalities, while deduction goes from generalities to specific instances. For example, pagaclone was brought to trials for stuttering (deduction) when it was observed that one person in pagaclone trials for anxiety found his fluency improved (induction).
What has surprised me is that so few of your blog readers (aside from parents of children who stutter) have reported (positive or negative) results from drug use. I'm beginning to wonder if adult stutterers are closet scientologists.

Ora McCreary said...

willme - I wonder why you're surprised that there have been few reports of effects on speech from drug use. The simplest explanation is that there are no standard drug therapies (yet) for stuttering. A few (olanzapine and risperdal) have shown some effect, but they're powerful and have side effects and they're rarely prescribed for stuttering.

As to negative reports (drug X makes my stuttering worse), I wouldn't expect people to mention them.... would you?

As far as I know, the literature surveys of pharmacological interventions for stuttering (such as the Bothe article I sent you) seem to confirm that there have not really been any significant positive results. (Or am I misinterpreting, or misinformed?)

What kinds of comments would you expect to see?

willme said...

I'm not proposing the use of "standard (drug) therapies" of which there are none known. Given previous posts on this blog, and from the literature review according to Arp, it appears that stutterers are a heterogeneous group when it comes to brain chemistry and drug responses; it may be very difficult to glean positive (non-placebo) effects from drug trials if stutterers are treated as a homogeneous group. If so, then individual drug experimentation is in order (weighing, of course, the risks associated with any given drug). This is part of the proposed inductive approach (see my first comment). Basically, at this point we should forget about positive results from standardized trials before we try anything.
As to "what kind of comments I would expect to see?" Well, I reported on remarkable success with 2mg of ativan. Has anyone else out there tried it? The kinds of comments I would expect are: (1) Yes, it did work for me, (2)It partially improved my fluency, or (3) Willme, you are full of s___, it had no effect whatsoever on my fluency. In simple terms, I want to know for what fraction of stutterers this drug regimen works. Then I want to know what (in terms of brain chemistry) makes this group unique? These are the kinds of questions the research community should be focusing on.
I think that traditional speech therapy does a great disservice to disfluents by pretty much ignoring the possibility of drug therapy.

Ora McCreary said...

Willme - I see what you mean. A couple of questions:

1) You refer to a literature review according to Arp. I'm not familiar with that. Can you give a specific reference? Is it available online? The only hits Google gives for "stuttering arp" are related to a synthesizer called ARP. (I sometimes wish there were a way to do a word search on a blog, so I could look to see if something's already been mentioned. Do you know of such a function?)

2) I am familiar with your point about subgroups from previous posts by you and Tom. (I thought you might be referring to that.) However, I remain skeptical that standard drug studies ignore such results in subgroups. Are you suggesting that the trials or experiments are usually simply too small for statistically significant subgroups to be identified? I may be wrong, but I would assume that researchers in general are alert to the possibility that an effect may be visible within some subgroup. I've undoubtedly done far less reading in this field than you, but wouldn't a researcher be on the lookout for effects in subgroups, and anxious to publish those results rather than to report the absence of results (or at least the absence of positive results)?

3) What did you mean when you referred in your earlier post in this thread to "negative" results? I was (mis?)interpreting it to mean negative effects on fluency, rather than merely the absence of positive effects?

4) I've also wondered about your last observation. I'm puzzled that the "stuttering community" (both therapists and support groups that I've participated in) have rarely mentioned any drugs. I've been in and out of speech therapy for all my adult life, and I would have imagined that drug therapy would be at least mentioned more that it has been. No one has ever suggested to me "why don't you see your doctor and try Ativan/inderal/antidepressants, etc. for your speech-related anxiety?" Nor do they mention that they make such suggestions to others. Speech therapists can't prescribe drugs, of course, but the same is true of psychotherapists (except psychiatrists), and as far as I know, psychotherapists recommend drugs all the time, and commonly have specific psychiatrists to which they refer their patients. Why not speech therapists?

Leo said...

The treatment of the stuttering urgently needs to involve professionals of other areas and leave of to be monopolized by speech therapists. After all, the disorder many times involves some aspects and symptoms with which speech therapists are not prepared for handle.

Anonymous said...

In the US, in order to have an insurance company pay for Speech services, a doctor has to prescribe speech therapy. So, a speech therapist could infer, that any recommendations would have come from the doctor's knowledge of the patient and how the Speech therapy is going (because of needing to maintain the Rx).
In our case, it has been a bit more convoluted. When I was really searching for how to help my son's ADD, I asked on this blog and that led to the articles you recommended (Per Alm I think). Also, Alex's speech therapist did weigh in re: treatment that might not affect his stuttering, and in another patient, had helped the stuttering.
I have been amazed by the odd reaction to the ADD medicine-- Stratera (supposedly better for stuttering) made the stuttering MUCH worse. Adderall slightly improved the already better fluency with Lexapro.
I still have hope that there is one key to both problems...If there was a way to really see how each person's brain functioned--to say--how the function is produced.
The oddest negative reaction to stuttering was with a medicine to calm the nervous system's effect on the digestive tract--Alex became even unable to speak at all.