Elective mutism: A 17-year-old girl treated successfully with citalopram

Abstract

This case-report presents a 17-year-old girl who had had elective mutism since the age of 6 years and was treated successfully with citalopram. In addition to the elective mutism she also showed signs of comorbid symptoms such as obsessive-compulsive rituals, abnormal eating habits, and social phobia. The patient showed a limitation in social skills but appeared not to have a cognitive-based social dysfunction or any pervasive developmental disorder. Before medical treatment at the age of 17 years she had been treated with family therapy, individual psychotherapy, and behavioural therapy/milieu therapy during periods of in- and outpatient status. None of these treatment strategies had shown any significant improvement with regard to socializing or speaking in public. The girl was treated with citalopram, a highly specific selective serotonin reuptake inhibitor, with a maximum dosage of 40 mg/day, without reported side effects. After several weeks of medication her speech gradually increased, and she was able to engage more in social settings. The dosage was later reduced to 20 mg/day, with a subjective feeling of deterioration in her speech difficulties. She did not, however, experience any relapse of her elective mutism during the following year, on continued dosage of 20 mg. This case report suggests that citalopram may be safe and efficacious in the treatment of some cases of severe elective mutism, but controlled studies are still required.