Sustained-release bupropion in the treatment of SSRI nonresponder pathologic gamblers: pilot study and review of the literature

Pinhas N Dannon, Katherine Lowengrub, Ernest Musin, Yehudit Gonopolski and Moshe Kotler

Background: Pathologic gambling (PG) is a prevalent and disabling impulse-control disorder. Recent studies have consistently demonstrated that PG patients respond well to treatment with selective serotonin reuptake inhibiters (SSRIs), mood stabilizers and opioid antagonists. These findings have supported the observation that PG is strongly associated with mood disorders, obsessive–compulsive spectrum disorders, panic disorder and addictive disorders. The aim of the study was to show the effectiveness of bupropion sustained release in PG. Methods: A total of 16 male PGs who had failed two previous trials of SSRI pharmacotherapy were enrolled in the study and were treated with bupropion sustained release for 12 weeks. A comprehensive psychiatric diagnostic evaluation was performed on all patients at baseline, and patients were screened for symptoms of gambling, depression and anxiety using the South Oaks Gambling Screen, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale and the Clinical Global Impression-Impovement Scale. In addition, the patients completed self-report questionnaires concerning their demographic status. Results: Most patients responded well to bupropion treatment. A total of 12 out of 16 subjects completed the 12-week treatment program. Treatment response was determined by the level of gambling behavior reported by subjects at the 12-week visit. Full remission of gambling behavior was defined as the absence of gambling behavior for a period of 1 week prior to the follow-up visit. A total of nine out of the 12 completers reported full remission, and three completers had partial remission. Conclusion: Bupropion SR could be effective in the treatment of pathologic gamblers who are SSRI nonresponders.