Antipsychotic May Fuel Urge to Gamble

Megan Brooks

May 15, 2018

NEW YORK — An updated literature review provides more evidence of an association between gambling disorder and the second-generation atypical antipsychotic aripiprazole (Abilify, Otsuka).

Aripiprazole-related gambling disorder has been "increasingly" reported in the literature, especially in Europe, Australia, and the United States, lead investigator Yam Giri, MD, from Jamaica Hospital Medical Center and Northwell Health–Zucker Hillside Hospital in New York City and Glen Oaks, New York, told Medscape Medical News.

The findings were presented here at the American Psychiatric Association (APA) 2018 annual meeting.

Look for Signs of Impulsivity

In May 2016, the US Food and Drug Administration warned of problems regarding impulse control, including compulsive gambling, binge eating, hypersexuality, and compulsive shopping, associated with aripiprazole. Pathologic gambling is listed as a reported side effect on aripiprazole drug labels.

From 2000 to 2012, the agency received reports of 184 cases of a possible association between aripiprazole and impulse control disorders; gambling disorder accounted for 164 (89%) of these cases.

To further explore ties between gambling disorder and aripiprazole, Giri and colleagues conducted a systematic review of the literature through April 7, 2017. They identified 21 published cases of gambling disorder that were possibly associated with aripiprazole treatment. The mean age of the patients (20 men, 1 woman) was 34.7 years. Aripiprazole was most commonly prescribed for schizophrenia and bipolar disorder.

Of the 21 patients, 14 had a history of prior gambling, and four had no prior gambling history. For three patients, no such history was reported.

After beginning treatment with aripiprazole, 12 patients showed an increase in preexisting gambling behavior, and nine started gambling. In addition to gambling disorder, three patients had other impulse control disorders, such as compulsive eating, compulsive shopping, or hypersexuality.

The severity of gambling disorder was assessed on the basis of the number of Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria the patients met. The DSM-IV lists 10 such criteria; the average number of those criteria that the patients met was seven (reported for 11 patients).

In most patients, gambling urges resolved within a few weeks to a few months after the drug was discontinued.

"Doctors should be vigilant" of the association between aripiprazole and gambling disorder and should assess patients for impulsive behavior and gambling history before starting aripiprazole, Giri told Medscape Medical News. "Once on aripiprazole, patients should also be monitored regularly for gambling behavior or other impulse control disorder," he said.

Aripiprazole is thought to cause impulse control disorders through the hyperdopaminergic state in the brain's reward system that occurs as a result of partial agonist action in D2 receptors and agonist properties in D3 receptors.

"Parkinson's disease drugs and some antidepressants that also have an affinity for the neurotransmitter dopamine" can also lead to impulse control disorders, Mahyar Etminan, PharmD, from the University of British Columbia in Vancouver, Canada, who was not involved in the study, told Medscape Medical News.

This new analysis "seems to do good job highlighting the available evidence on the topic," Etminan said.

He said he is not sure whether most clinicians are aware of this association. For a patient with a known impulse control disorder, "there are a number of antipsychotics that might have a different risk profile on impulse control that clinicians can use," said Etminan.

The study had no commercial funding. The authors and Dr Etminan have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2018. Poster P4-166, presented May 6, 2018.

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