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Phenelzine treatment of selective mutism in four prepubertal children
Insights
Phenelzine effectively treated selective mutism in four children. This medication is recommended for cases unresponsive to behavior therapy or fluoxetine, despite potential side effects.
Area of Science:
- Child and Adolescent Psychiatry
- Pharmacology
- Clinical Psychology
Background:
- Selective mutism is an anxiety disorder characterized by a child's inability to speak in specific social situations.
- Previous treatments have included behavioral therapy and selective serotonin reuptake inhibitors (SSRIs).
Observation:
- Four children diagnosed with selective mutism, aged 5.5 to 7 years, were treated with phenelzine.
- Three children initially received phenelzine, while one child showed minimal improvement with fluoxetine before starting phenelzine.
- Phenelzine treatment ranged from 30-60 mg/day for 24-60 weeks.
Findings:
- Phenelzine was well-tolerated, with weight gain as the most common side effect.
- No hypertensive reactions or serotonin syndromes were observed.
- All four children experienced successful treatment of selective mutism without recurrence after discontinuation.
Implications:
- Phenelzine demonstrates efficacy in treating selective mutism, particularly in treatment-resistant cases.
- Due to potential drug and food interactions, phenelzine should be considered a second-line treatment after behavioral therapy and SSRIs.
- Further research into phenelzine's role in pediatric anxiety disorders is warranted.
Abstract:
Four children, ages 5 1/2 to 7 years, diagnosed with selective mutism and successfully treated with phenelzine are presented. All four children were anxious and extremely shy and had family histories of anxiety and shyness. The first three children were treated with phenelzine prior to reports that fluoxetine was helpful in some cases. The fourth child was treated initially with fluoxetine and had shown only minimal improvement after 10 months of doses up to 16 mg daily. Phenelzine doses ranged from 30 to 60 mg/day and treatment, including medication taper, lasted from 24 to 60 weeks. The phenelzine was generally well-tolerated and weight gain was the most common side effect. No hypertensive reactions or serotonin syndromes occurred. There was no recurrence of mutism after medication discontinuation. The authors conclude that phenelzine can be an effective treatment for selective mutism, but because of the possibility of serious food and drug interactions and the necessary dietary restrictions, it should be reserved for cases that do not respond to behavior therapy and fluoxetine or other specific serotonin reuptake inhibitors.
