fluvoxamine and Gambling

Medication treatment studies have demonstrated short-term efficacy of various SRIs, opioid antagonists, and mood stabilizers in sub-samples of adult treatment seeking pathological gamblers. Pathological gambling is frequently comorbid with bipolar spectrum disorders, substance abuse/dependence, and attention-deficit/hyperactivity disorder (ADHD), and comorbidity may influence treatment response in pathological gambling. This review focuses on recent research examining the treatment of pathological gambling and highlights methodological challenges for future studies.

Topics: Antidepressive Agents, Second-Generation; Behavior, Addictive; Bupropion; Comorbidity; Disruptive, Impulse Control, and Conduct Disorders; Dose-Response Relationship, Drug; Fluvoxamine; Gambling; Humans; Naltrexone; Outcome Assessment, Health Care; Paroxetine; Piperazines; Research Design; Selective Serotonin Reuptake Inhibitors; Substance-Related Disorders; Triazoles

The legalization and availability of new forms of gambling are increasing in most Western countries. This trend has contributed to the fact that more individuals are developing gambling problems. As a result, there is a need for effective treatments. Although gambling treatment dates several decades, few empirically supported treatments for pathological gambling have been developed. This critical review includes only controlled treatment studies. The primary inclusion criterion was randomization of participants to an experimental group and to at least 1 control group. Eleven studies were identified and evaluated. Key findings showed that cognitive-behavioral studies received the best empirical support. Recommendations to improve gambling treatment research include better validated psychometric measures, inclusion of process measures, better definition of outcomes, and more precise definition of treatments.

Topics: Behavior, Addictive; Cognitive Behavioral Therapy; Fluvoxamine; Gambling; Guidelines as Topic; Humans; Naltrexone; Narcotic Antagonists; Selective Serotonin Reuptake Inhibitors; Self-Help Groups

Pathological gambling is a disabling disorder that affects at least 2 1/2 million Americans and their families. Although pathological gambling has been characterized as an impulse control disorder, it has also been associated with compulsivity. Essential features of pathological gambling include constantly recurring gambling behavior that is maladaptive, in that personal, familial, and/or vocational endeavors are disrupted. Affective disorders and substance abuse often co-occur. Incidence of suicidality is extremely high. Despite the fact that this disorder is a widespread public health problem, few controlled studies of causes or treatment have been conducted. Preliminary neurobiological studies implicate serotonergic dysfunction in pathological gamblers. Treatment with serotonin reuptake inhibitors, such as clomipramine and fluvoxamine, may be effective in treating this disorder. Well-defined and controlled clinical trials in large samples of pathological gamblers are needed.

Topics: Adolescent; Adult; Comorbidity; Compulsive Behavior; Disruptive, Impulse Control, and Conduct Disorders; Female; Fluvoxamine; Gambling; Humans; Lithium Carbonate; Male; Middle Aged; Mood Disorders; Obsessive-Compulsive Disorder; Placebo Effect; Psychotherapy; Selective Serotonin Reuptake Inhibitors; Self-Help Groups; Serotonin; Substance-Related Disorders; Treatment Outcome

The objective of this study was to evaluate the efficacy of fluvoxamine in the treatment of pathological gambling. Thirty-two patients were treated for 6 months in a double-blind, placebo-controlled study of fluvoxamine 200 mg/day. Outcome measures included reduction in money and time spent gambling per week. Longitudinal mixed effects models and completers analyses were used for estimation and hypothesis testing. Fluvoxamine was not statistically significantly different from placebo in the overall sample. However, fluvoxamine was statistically significantly superior to placebo in males and in younger patients. The power of the study was limited by the high (59%) placebo-response rate. Fluvoxamine may be a useful treatment for certain subgroups of patients with pathological gambling. Several methodological recommendations are made for future pharmacological trials of pathological gambling.

Topics: Adult; Age Factors; Disruptive, Impulse Control, and Conduct Disorders; Double-Blind Method; Female; Fluvoxamine; Gambling; Humans; Male; Pilot Projects; Selective Serotonin Reuptake Inhibitors; Sex Factors; Treatment Outcome

The study assessed the efficacy and tolerability of the selective serotonin reuptake inhibitor (SSRI) fluvoxamine in the treatment of pathologic gambling (PG).. A 16-week randomized double-blind crossover design insured that each subject received 8 weeks of fluvoxamine and 8 weeks of a placebo. Fifteen patients entered and 10 subjects, all male, completed the study.. Fluvoxamine resulted in a significantly greater percent improvement in overall gambling severity on the PG Clinical Global Impression (PG-CGI) scale. There was a significant drug effect on gambling urge and behavior as measured by the PG modification of the Yale-Brown Obsessive Compulsive Scale and PG-CGI scale improvement scores; however, there was a significant interaction of drug effect with the order of administration of drug and placebo. Post hoc analysis, treating each phase as a separate trial, demonstrated a significant difference between fluvoxamine and the placebo in the second phase of the trial but not in the first. Fluvoxamine side effects were of only mild intensity and consistent with SSRI treatment and were not associated with early withdrawal from the study.. These findings suggest that fluvoxamine is well tolerated and may be effective in the treatment of PG in an acute trial, and that an early placebo effect in PG treatment appears to diminish over time. To confirm this finding and to determine whether improvement persists over an extended period of time, a longer duration parallel-design trial with long-term maintenance follow-up should be conducted in a larger and more diverse PG population.

Topics: Adult; Antidepressive Agents, Second-Generation; Cross-Over Studies; Double-Blind Method; Fluvoxamine; Gambling; Humans; Male; Middle Aged; Psychiatric Status Rating Scales

The authors' goal was to assess the efficacy and tolerability of the selective serotonin reuptake inhibitor fluvoxamine in the treatment of pathological gambling.. Sixteen patients with pathological gambling entered an 8-week placebo lead-in phase, and 10 of these patients completed an 8-week single-blind fluvoxamine trial.. Seven of the 10 patients who completed the fluvoxamine trial were judged treatment responders at the end of the study: 1) they had greater than 25% decreases in their gambling behavior scores on the pathological gambling modification of the Yale-Brown Obsessive Compulsive Scale, and 2) their clinician-rated Clinical Global Impression scores for gambling severity were very much improved or much improved. Fluvoxamine treatment resulted in gambling abstinence in seven of the 10 patients.. Findings from this preliminary study suggest that fluvoxamine may be effective in reducing the urge to gamble. Randomized placebo-controlled and maintenance trials are required to confirm these findings and to determine whether improvement persists.

Topics: Adult; Disruptive, Impulse Control, and Conduct Disorders; Drug Administration Schedule; Female; Fluvoxamine; Gambling; Humans; Male; Middle Aged; Placebos; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Single-Blind Method; Treatment Outcome

Legalized gambling is a growing industry, and is probably a factor in the presently increasing prevalence of pathological gambling. We present a case of a 36-year-old pathological gambler who was treated with fluvoxamine, a selective serotonin reuptake inhibitor, and who was assessed by functional MRI before and after drug administration. During activation periods, the pathological gambler was shown cards as stimuli, and fMRI results in several brain regions showed differential effects before and after medication and a maintenance period. This case demonstrates that the treatment response to fluvoxamine in a pathological gambler was observed not only by subjective self-report, but also by objective fMRI results. Therefore, fMRI may be a useful tool in the diagnosis and prediction of treatment response in patients afflicted with pathological gambling.

Topics: Adult; Behavior, Addictive; Fluvoxamine; Gambling; Humans; Magnetic Resonance Imaging; Male; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Pathological gambling (PG) is a relatively common and highly disabling impulse control disorder. A range of psychotherapeutic agents including selective serotonin reuptake inhibitors, antiepileptic drugs, and opioid antagonists are shown to be effective in the short-term treatment of PG. The use of a wide range of pharmacological treatments for PG is consistent with the observation that PG shares features of obsessive-compulsive spectrum disorders, impulse control disorders, and addictive disorders. The aim of the study is to assess the rate of relapse in treatment-responder pathological gamblers after discontinuation of the active treatment.. Our study sample was composed of 43 male pathological gamblers who had been full responders to 1 of 4 drug treatment regimens (fluvoxamine, topiramate, bupropion SR, or naltrexone) from several previous acute open-label (12-week) comparison studies. Full response was defined as the absence of gambling for a 1-month duration together with improvement on the Clinical Global Improvement scale. The 43 full responders were then followed prospectively for an additional 9 months, which included a 3-month open-label continuation phase and a 6-month medication-free follow-up phase. Follow-up visits were performed on a monthly basis throughout the duration of study. At every follow-up visit, a comprehensive psychiatric diagnostic evaluation was performed on all patients, and patients were assessed for symptoms of gambling using a self-report instrument and collateral family reports. The Clinical Global Impression Improvement scale was also administered at every follow-up visit. Raters were blind to the previous drug treatment.. Most patients did not relapse during the 6-month medication-free follow-up phase. Three of 6 patients with fluvoxamine, 3 of 9 with topiramate, 7 of 18 with bupropion SR, and 4 of 10 with naltrexone relapsed. Relapse was strictly defined as gambling behavior at any time during the 6-month medication-free follow-up period. Most of the patients did not gamble during the follow-up period, and the patients that did gamble reported a decrease in gambling losses.. This naturalistic long-term follow-up outcome study demonstrates that among pathological gamblers who respond to a 6-month trial of medication, most patients seem to maintain full-response during a 6-month medication-free follow-up phase. Further studies are needed to confirm our findings.

Topics: Adolescent; Adult; Analysis of Variance; Bupropion; Delayed-Action Preparations; Drug Therapy; Fluvoxamine; Follow-Up Studies; Fructose; Gambling; Humans; Israel; Male; Middle Aged; Naltrexone; Outcome Assessment, Health Care; Psychiatric Status Rating Scales; Psychopharmacology; Recurrence; Reproducibility of Results; Surveys and Questionnaires; Time Factors; Topiramate

The pathological eating behaviour of patients with anorexia nervosa reflects a deficit in planning real-life strategies that can be observed in an experimental setting through the Gambling Task, a tool designed to detect and measure decision-making abilities. We examined the role of Gambling Task performance as a predictor of treatment outcome in anorectic patients, and we evaluated changes in decision-making after clinical improvement. Performance on the Gambling Task was evaluated, and a clinical-nutritional assessment of 38 anorectic patients was carried out before and after a cognitive-behavioural and drug treatment program. Task performance of anorectic patients was compared with that of 30 healthy control participants. Patients who had a better decision-making profile at baseline showed significantly greater improvement in nutritional status. The decision-making deficiency of some anorectic patients is probably linked to those individual features that contribute to the phenomenological expression of the disorder and to its different treatment outcomes.

Topics: Adult; Anorexia Nervosa; Body Mass Index; Cognition Disorders; Cognitive Behavioral Therapy; Combined Modality Therapy; Decision Making; Demography; Female; Fluoxetine; Fluvoxamine; Gambling; Humans; Interview, Psychological; Neuropsychological Tests; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome

The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) was developed to measure the severity and change in severity of pathological gambling symptoms. The PG-YBOCS is a 10-item clinician-administered questionnaire that measures the severity of PG over a recent time interval (usually within the past one/two week(s)). In order to assess and validate the scale, it was administered to 337 subjects: 188 pathological gamblers and 149 healthy controls. Internal consistency and correlations between individual items and total score were assessed for various permutations of the sample. Other scales were administered to assess convergent, discriminant and content validity. Sensitivity to change was evaluated in treatment studies with fluovoxamine, lithium, and valproate. Each item was frequently endorsed across a range of severity. Good inter-rater reliability and internal consistency were obtained. The PG-YBOCS showed high validity and reliability for total score, item-total correlations, and for each subscale (Thoughts/Urges and Behavior). PG-YBOCS scores correlated with global severity and South Oaks Gambling Screen (SOGS) scores. The scale was also sensitive to change in pathological gambling severity. PG-YBOCS thus appears to be a reliable and valid measure of pathological gambling severity, and can be regarded as an important tool for clinicians and researchers treating pathological gamblers.

Topics: Adult; Disruptive, Impulse Control, and Conduct Disorders; Female; Fluvoxamine; Gambling; Humans; Lithium; Male; Obsessive-Compulsive Disorder; Psychometrics; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Surveys and Questionnaires; Valproic Acid

Pathological gambling (PG) represents the end spectrum of gambling behaviours. It is characterised by constantly recurring gambling behaviour which is maladaptive. This case illustrates how an Asian woman pathological gambler progresses through the different stages of development of the gambling habit, and how a multi-modal treatment approach has helped her regain psychosocial function. In addition, the maintenance factors, typical and atypical associated features, and difficulties in the management of such a case are highlighted.

Topics: Adult; Anti-Anxiety Agents; Combined Modality Therapy; Family Therapy; Female; Fluvoxamine; Gambling; Humans; Psychotherapy; Treatment Outcome