Can Medications Help People With Gambling Disorder?
Abstract
While there are no FDA-approved medications for the treatment of disordered gambling, several studies suggest that medications commonly used to treat other addictive and psychiatric disorders may reduce gambling urges.
One of the significant changes in DSM-5 was the reclassification of gambling disorder from an “Impulse Control Disorder Not Otherwise Specified” to a “Substance-Related and Addictive Disorder” (1-2). This change was due in part to the similarities between gambling disorder and substance use disorders in some symptom presentations, biological dysfunctions, genetic liabilities, and treatment approaches (3).
To meet the criteria for a DSM-5 diagnosis of gambling disorder, a patient must meet four or more of the following criteria:
Gambling with increasing amounts of money to achieve desired excitement
Restlessness or irritability when attempting to control or stop gambling
Repeated, unsuccessful efforts to cut back or stop gambling
Preoccupation with gambling
Gambling when distressed
“Chasing” one’s losses
Lying to hide extent of gambling involvement
Jeopardizing or losing significant relationships, jobs, or more because of gambling
Asking family or friends for money to relieve desperate financial situations caused by gambling
The lifetime prevalence of gambling disorder may be low (approximately 1 percent of people will experience gambling disorder); however, those with the disorder are more likely to have poor heath and to experience comorbid conditions such as substance use disorders, mood disorders, and anxiety disorders (4-5).
There are no FDA-approved medications for the treatment of disordered gambling; however, several studies suggest that medications used to treat other addictive and psychiatric disorders may reduce problem gambling.
The most promising of these are the opioid receptor antagonists, naltrexone and nalmefene. These agents have been shown to reduce gambling urges and gambling behaviors, such as time and amount of money spent on gambling, as measured by the Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS), when compared with placebo (6-8).
Trials evaluating the effectiveness of antidepressants for treating disordered gambling have produced mixed results. One study of fluvoxamine (9) and one study of paroxetine (10) showed that each was superior to placebo for treating disordered gambling, but subsequent studies of each medication did not support the initial findings (11-12). Sertraline (13) and bupropion (14) are no better than placebo while citalopram (15) and escitalopram (16) have shown promise in treating problem gambling in open-label trials.
In a single-blind trial, the mood stabilizers lithium and divalproex were equally effective at reducing gambling severity for problem gamblers who did not have bipolar disorder (17). Unfortunately, there was no control group comparison, so it is unclear if these medications are better than placebo.
Studies of the antiepileptic medication topiramate (18) and the antipsychotic medication olanzapine (19-20) suggest that they are no better than placebo for treating gambling problems.
Interestingly, modafinil, an atypical stimulant used to treat narcolepsy, decreased the desire to gamble as well as engage in risky decision making in highly impulsive gamblers but had the opposite effect on gamblers with low impulsivity during a brief gambling episode using slot machines (21). Lastly, open-label trials of memantine (22), acamprosate (23), and N-acetyl cysteine (24) have shown that these medications may be effective for reducing gambling urges and gambling behaviors, as measured by the PG-YBOCS.
While the studies cited above show that effective pharmacologic treatments for gambling disorder exist, most of these trials had small sample sizes and were of short duration. More studies with larger numbers of subjects that take place over a longer period are needed to help clarify what pharmacologic treatments may be effective for gambling disorder.■
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