Study design

Duration

Drug, dosage

Subjects

Type of gambling

Outcome

Comments

Double-blind

Hollander et al (1992)

20 weeks (10 each phase)

Clomipramine

150 mg

N=1, female, 31 y.o.

Bingo, slots, cards, numbers

Brief relapse week 17, otherwise abstinent during trial with 7 months open maintenance at 175 mg

Comorbid social phobia, OCPD, hoarding

Haller & Hinterhuber (1994)

24 weeks (12 each phase)

Carbamazepine 600 mg

N=1, male, 37 y.o.

Roulette

Abstinent for duration of trial and during 2 1/2 yrs open maintenance

Impressive result given long history, previous Rx failures, absence of comorbidity

Hollander et al (2000)

17 weeks (8 week crossover)

Fluvoxamine

100-250 mg (mean dosage 195 mg)

N=15,

10 (all male)

completed week 12

Sports, horse racing predom.

67 % vs 25 % improvement on PG-CGI.

Improvement on PG-YBOCS not stat.signif. 

only 4 fluvoxamine responders

Kim et al  (2001)

12 weeks (11 on naltrexone or placebo)

Naltrexone

100-250 mg

(mean dose 188 mg)

N=83, mostly women, 45 completed week 6

Slot machines

75 % (15/20) improved or very much improved on PG-CGI vs 24% on placebo

Higher gambling urges at baseline responded better.

Elevated LFTs due to analgesics.

Blanco et al (2002)

6 months (randomized to fluvoxamine or placebo)

Fluvoxamine

100-250 mg

N=32 (66% male)

No information

Fluvoxamine not statistically different from placebo in time and money spent gambling.

Only 3/15 on medication completed

54% placebo response at end of 4 months (but lack of data on use of gambling self-help, therapy groups)

Kim et al (2002)

8 weeks (randomized after 1 week placebo lead-in)

Paroxetine

10-60 mg

(mean dose 51.7 mg)

N=45 (30 women, 15 men),

41 completed.

Mainly slots (91.3% of paroxetine group) or bingo (26.1%)

Significant improvement on CGI and G-SAS by wk 6-8

No signif. difference between groups in percentage of weekly income lost to gambling (20% vs 12.2%)

Single -blind

Duration

Drug, Dosage

Subjects

Type of gambling

Outcome

Comments

 Hollander et al (1998)

8 week placebo lead in followed by 8 weeks of medication

Fluvoxamine

100-300 mg

(mean dose 220 mg)   

N=16,

10 (6 males, 4 females) completed

Sports, horses (male), poker machine, slots, lottery (female)

7/10 responded positively to CGI, PG-YBOCS, decreased craving and abstinence

2/3 non-responders had comorbid cyclothymia.

Pallanti et al (2002)

14 weeks (randomized to lithium or valproate)

Lithium 600-1200 mg (mean dose 795 mg) vs. valproate 600-1500 mg (mean dose 874 mg)

N=42, 32 male, 10 female

Video poker  (26), horses (18), lotto (12),

cards (10), stocks (6), sports (5)

14/23 lithium responders,

13/19 valproate responders to CGI, also to PG-YBOCS. But high dropout rate for lithium group – 8/23 (34.8%)

Tried to exclude BD but soft bipolars may have been included.

Mood stabilizers may have anti-impulsive effect.

Open-label

Kim & Grant (2001)

6 weeks

Naltrexone 25-250 mg (mean dose 157 mg)

N=17 (7 male, 10 female). 14 completers

No information

Signif. decreases in CGI and G-SAS. Response by week 4. Most stopped gambling by week 6.

2 gamblers relapsed when medication stopped, suggesting not placebo response

Zimmerman et al (2002)

12 weeks

Citalopram 10-60 mg (mean dose 34.7 mg)

N=15, 9 completed

Machine, lottery

Decreased days gambling, money lost, urges and preoccupation. Improved by week 2

8/15 had MDD at baseline, 3/15 with panic disorder. New instrument - OCDS

Case reports

Moskowitz (1980)

Continued on medication 1 1/2—2 1/2 years, third not known

Lithium 1800 mg

N=3 (all male), 3/3 bipolar disorder

Horse racing, poker, stock market

Abstinence, loss of interest in gambling, emotional stability, general improvement.

Corroborated by family members. Long- term follow-up

All were binge gamblers, mainly coincided with manic cycles

Crockford  & el –Guebaly (1998)

4 weeks

Naltrexone 50 mg

N=1, male,

49 y.o.

VLTs

Cessation of gambling craving within 48 hours.

Already abstinent. Specific effect on cravings

Kim (1998)

2+ weeks, 9 months maintenance

Naltrexone

100 mg

N=1, male,

55 y.o.

Casino (machines)

Cessation of anticipatory excitement to gamble once Naltrexone reached 100 mg

Remained abstinent from gambling and compulsive shopping