Pharmacotherapy and gambling

Q: 58 years old male is admitted to ICU with suicidal ideation after losing most of his assets due to pathological gambling. Besides psychotherapy, which of the following medicines is found to have beneficial effects independent of other factors? - select one

A) Fluvoxamine

B) Haldol

C) Valproic acid

D) Thorazine

E) Methadone

Answer: A

Evidence, though weak, showed that selective serotonin reuptake inhibitors (SSRIs) may be effective in reducing gambling behaviors independent of their effect on mood, depression, or anxiety. The two most studied drugs in this regard are fluvoxamine (choice A) and sertraline. Other SSRIs such as citalopram and fluoxetine are also found to be effective.

Other drugs which have been suggested are bupropion, naltrexone, nalmefene, lithium, and topiramate.

All these drugs have a higher effect if combined with psychotherapy.

#psychiatry

References:

1. Hollander E, DeCaria CM, Finkell JN, et al. A randomized double-blind fluvoxamine/placebo crossover trial in pathologic gambling. Biol Psychiatry 2000; 47:813.

2. Saiz-Ruiz J, Blanco C, Ibáñez A, et al. Sertraline treatment of pathological gambling: a pilot study. J Clin Psychiatry 2005; 66:28.

3. Zimmerman M, Breen RB, Posternak MA. An open-label study of citalopram in the treatment of pathological gambling. J Clin Psychiatry 2002; 63:44.

4. Gandara, JJ, Sanz, O, Gilaberte, I. Fluoxetine: open-trial in pathological gambling. 152nd Annual Meeting of the Am Psych Association 1999.

5. Kraus SW, Etuk R, Potenza MN. Current pharmacotherapy for gambling disorder: a systematic review. Expert Opin Pharmacother 2020; 21:287.

6. Kim SW, Grant JE, Adson DE, Shin YC. Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling. Biol Psychiatry 2001; 49:914.

7. Hollander E, Pallanti S, Allen A, et al. Does sustained-release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders? Am J Psychiatry 2005; 162:137.