Effective Pharmacologic Interventions for Pathological Gambling Remain Limited
A systematic review presented at the 2025 NEI Spring Congress found that effective pharmacologic interventions for pathological gambling (PG) remain limited.
Researchers conducted a literature review of randomized controlled trials (RCTs) and case studies that investigated the efficacy of pharmacological interventions, including opioid antagonists, selective serotonin reuptake inhibitors (SSRIs), and psychedelic therapies, on PG behaviors. Primary outcomes were measured by the Pathological Gambling-Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS), Gambling Symptom Assessment Scale (G-SAS), and other clinical surveys.
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In the review, researchers identified 2 studies that demonstrated opioid antagonists’ efficacy on reducing PG behaviors. One of the included studies found that naltrexone significantly reduced PG behaviors based on clinical impression scales (n = 43). Nalmefene also reduced PG-YBOCS scores by at least 35% in a post hoc analysis, according to another included study (n = 233). Despite their efficacy, both naltrexone and nalmefene had high dropout rates, complicating their potential as long-term treatment.
Ketamine infusion therapy showed promise in a case study of a 44-year-old patient with PG and refractory depression. The report found that the patient’s PG-YBOCS score reduced significantly over 4 sessions (0.5 mg/kg ketamine hydrochloride), dropping from 31 to 7. However, the authors noted that further RCTs are necessary to better understand the therapy’s effectiveness.
SSRIs were not found to have a clear level of efficacy; for example, a trial investigating fluvoxamine (n = 15) showed improvement in PG behaviors on the PG-CGI, but did not outperform placebo on another clinical scale. “Given the high prevalence of major depressive disorder (MDD) among PG patients, SSRIs warrant further investigation but may not be a primary treatment,” wrote Kian Abolhoda, MS, Drexel University College of Medicine, Philadelphia, PA, and coauthors.
While the review confirmed that the pharmacologic treatment options for PG are limited, the authors suggested several potential research areas to support the expansion of treatment options.
“Future studies should prioritize long-term strategies, standardizing assessment scales, and evaluating psychedelic therapies for PG,” the authors wrote. “Additionally, exploring genetic predispositions, environmental influences, and neurobiological mechanisms may lead to more targeted treatments,” they concluded.
Reference
Abolhoda K, Kutidze K, Kuo J, Kaghazwala M. The pharmacologic management of pathological gambling: a review of opioid antagonists, SSRIs, and psychedelic therapies. NEI Spring Congress; May 8-10; Philadelphia, Pennsylvania.
