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How is medication used in the treatment of SM?

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The use of medication is based on the understanding that SM is related to social anxiety and there are medications that have been shown to help social anxiety disorder (or social phobia) in adults. In recent years, it has become clear that anxiety problems are related to an imbalance in some of the chemical messengers, or, neurotransmitters, of the brain. In particular, the neurotransmitter called serotonin seems to be involved.

Antidepressant medication in the form of serotonin reuptake inhibitors (SSRI's) such as Prozac, Paxil, Celexa, Luvox and Zoloft are often prescribed in the treatment of anxiety disorders. In addition to the SSRI's there are other medications that affect several of the neurotransmitters instead of just serotonin. Examples are Effexor, Serzone, Buspar and Remeron. Although none of these medications are approved by the food and drug administration (FDA) for use in treating SM in children, it is common for doctors to prescribe medications when there is reason to believe that they are safe and effective for a particular use.

There are several small-scale studies that have shown these types of medications to be effective in the treatment of SM. Of the few experts who have treated large numbers of children with SM, most report that these medications are very helpful and have a large margin of safety. Side effects are minimal and can usually be avoided by starting the medication at a very low dosage level and increasing it very gradually. Many children with SM seem to respond to a very low dosage of these medications so there is no need to keep increasing to higher levels. When combined with appropriate behavioral or cognitive-behavioral therapy, the treatment success rates are dramatically higher.

When medication is used as part of a treatment plan, the goal is usually to have the child take the medication for 9-12 months. This seems to be a sufficient time period to allow the child to decrease anxiety, become accustomed to speaking in most settings and for treatment gains to be maintained after the medication is stopped. When it is time to discontinue medication, it should always be tapered off slowly under a doctor's supervision to avoid adverse side effects that can occur if medication is decreased too quickly.

When should I use medication in my child's treatment?

The decision about whether or not to use medication should be made by consulting with a doctor who has experience using the recommended medications with children. The choice is also dependent on parents' comfort level. Parents are encouraged to become as educated as possible about the types of medications used for SM and other treatment options by asking many questions of their providers and reading the available literature in order to make an informed decision.

Medication is not always necessary in the treatment of SM but in many cases it appears to be very useful in helping the child to take the first steps in overcoming their anxiety. Until anxiety is lowered to a tolerable level, most children will have difficulty accomplishing even small goals toward speaking. This is especially true in cases in which the child has exhibited the SM symptoms for a long period of time, other available treatments have not helped the child to make improvement, or in cases where the child is also showing symptoms of depression. Medication is more likely to be prescribed in such cases where the mutism is more severe or chronic (such as with older children and adolescents).

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