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| Read: Medications |
 Medications
Posted By Dr Fung On 9/16/2003 10:40:06 PM In Read
The interest in using medications to treat selectively mute children arose mainly in the 1990s, until then child psychiatrists did not see the need to use such a potent treatment against what appeared to be a fairly "harmless" problem. In that there was no obvious immediate danger to the child or to his family, or to others. The medications available before this period was also deemed too "dangerous" in that the benefits do not outweigh the potential risks. The most common medication used in the past was a group of antidepressants known as tricyclic antidepressants (TCA) so named because of their chemical structure. These drugs were used for a number of conditions in childhood such as anxiety, school refusal and bedwetting.
As the idea of selective mutism as a variant form of social phobia grew, several psychiatrists began experimenting with a new group of medications called serotonin specific reuptake inhibitors (SSRI) of which Prozac was the first and best known. Two child psychiatrists in Boston started a controlled trial which showed that child put on Prozac showed significant improvement in their behaviours and a number also started to speak dramatically. Since then, various other SSRIs have been used in treatments of selectively mute children (these include Fluvoxamine (Luvox, Faverin) and Sertraline (Zoloft) ) A number of other medications have been used as well. These include the monoamine oxidase inhibitors (used to treat adult social phobia) and even antipsychotics such as Haloperidol.
It is believed that medications work in some selectively mute children through a number of possible pathways:
1. By reducing the social anxiety that is seen in some children.
2. By reducing the inhibitions these children have for speaking.
Modern medications are useful alternatives to consider because they have few side effects and if used in low doses, are acceptable modes of treatment for a chronically selectively mute child. Here is a case study.
Read about some of the medications that have been used:Fluoxetine (Prozac)
Citalopram (Celexa (in North America), Cipram (in Singapore))
Sertraline (Zoloft)
Fluvoxamine (Luvox (NA), Faverin(S)) Some of the older medications that have been used:Imipramine (Tofranil)
Haloperidol (Haldol)
Phenelzine (Nardil) There is no literature on the use of the following medications, but I have seen a number of children using these medications:Moclobemide (Manerix, Aurorix)
Paroxetine (Paxil, Seroxat) These are some of the situations in which medications should be considered:1. Social anxiety is prominent in the child and there is a strong family history of anxiety.
2. The problem is chronic despite different non pharmacological interventions.
3. The family is uninvolved in the treatment of the child.
4. The child has a learning disability and isn't motivated by behavioural approaches. It is important to remember that medications should not be the only means of treating the child but serve as one arm of a multimodal process. Thus medication with child, family and school interventions are the best combinations in persistent selective mutism.
Natural therapies and herbs
It is probably appropriate to write a little about use of natural therapies and herbs in the treatment of selective mutism. As I interact with parents, I get to hear of interesting treatments. As a scientist, my first comment would have to be whether such treatments have been tested and the evidence for their efficacy examined. Many treatments work purely on the belief of the parents and child. This is the "placebo effect". It has been shown that people improve when they see the doctor or someone they trust. Nonetheless, a number of herbs have been used by parents including St John's Wort. My basic advice to parents is that as long as the treatment is safe (and not too expensive), one can consider it. Some so called natural therapies can be toxic in high doses (example high dose vitamin therapy). Before embarking on such treatments, discuss with your physician about the decision and weigh the pros and cons carefully.
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