European Child & Adolescent Psychiatry

, Volume 25, Issue 6, pp 571–578 | Cite as

The use of medication in selective mutism: a systematic review

  • Katharina ManassisEmail author
  • Beate Oerbeck
  • Kristin Romvig Overgaard


Despite limited evidence, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are used to reduce symptoms of selective mutism (SM) in children unresponsive to psychosocial interventions. We review existing evidence for the efficacy of these medications, limitations of the literature, and resulting treatment considerations. Bibliographic searches were conducted in Medline, Embase, PsycInfo, Web of Science and Cochrane up to June 2015. Two reviewers independently sought studies of children with SM as primary psychiatric diagnosis, which reported response to medication treatment. Abstracts were limited to those reporting original data. Two reviewers independently assessed the ten papers reporting on >2 subjects regarding study design, key results, and limitations. Heterogeneity of designs mandated a descriptive summary. Symptomatic improvement was found for 66/79 children treated with SSRIs and 4/4 children treated with phenelzine. Only 3/10 studies had unmedicated comparison groups and only two were double-blinded. This review may be affected by publication bias, missed studies, and variability of outcome measures in included studies. Although there is some evidence for symptomatic improvement in SM with medication, especially SSRIs, it is limited by small numbers, lack of comparative trials, lack of consistent measures, and lack of consistent reporting on tolerability. The clinician must weigh this paucity of evidence against the highly debilitating nature of SM, and its adverse effects on the development of those children whose progress with psychosocial interventions is limited or very slow. Studies of optimal dosage and timing of medications in relation to psychosocial treatments are also needed.


Selective mutism Pharmacotherapy Selective serotonin reuptake inhibitors Review 



We thank librarian Ellen Bjoernstad, Oslo University Hospital, for the literary searches.

Compliance with ethical standards

Financial disclosure

Katharina Manassis receives royalties for books related to child mental health from Barron’s Educational, Guilford, and Routledge; she has received one unrestricted educational honorarium from Shire Pharmaceuticals. Beate Oerbeck and Kristin Overgaard have no relevant financial relationships to disclose.

Conflict of interest

Katharina Manassis has no potential conflicts of interest apart from the financial disclosures above. Beate Oerbeck and Kristin Overgaard have no potential conflicts of interest to disclose.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Katharina Manassis
    • 1
    Email author
  • Beate Oerbeck
    • 2
  • Kristin Romvig Overgaard
    • 2
  1. 1.Department of PsychiatryUniversity of TorontoTorontoCanada
  2. 2.Division of Mental Health and AddictionOslo University HospitalOsloNorway

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