Lithium and Valproate Treatment of Pathological Gambling

Abstract

The aim of the present study was to evaluate the efficacy and safety of lithium and valproate in nonbipolar pathological gamblers. Method: Forty-two subjects with DSM-IVdefined pathological gambling entered a 14-week single-blind trial with lithium (N = 23) or valproate (N = 19). A total of 15 subjects on lithium treatment and 16 patients on valproate treatment completed the 14-week protocol. Results: At the end of the 14-week treatment period, both the lithium and the valproate groups showed significant (p < .01) improvement in mean score on the Yale-Brown Obsessive Compulsive Scale modified for pathological gambling. This improvement did not significantly differ between groups. Fourteen (60.9%) of the 23 patients taking lithium and 13 (68.4%) of the 19 patients taking valproate were responders based on a Clinical Global Impressions-Improvement score of much or very much improved. Conclusion: Findings from the present study suggest the efficacy of both lithium carbonate and valproate in the treatment of pathological gambling. This is the first controlled trial of the efficacy of mood stabilizers in pathological gambling. A double-blind, placebo-controlled trial is required to confirm these findings.

Pathologisch gokken: impulscontrolestoornis en gedragsmatige verslaving

“…Pathologische gokkers met ADHD bleken goed te reageren in een open label trial met bupropion, een dopamineheropnameremmer (Black, 2004), maar een recente dubbelblind gecontroleerde studie liet een even groot effect zien voor bupropion en placebo (Black et al, 2007). Medicatie gebruikt bij bipolaire stoornissen, zoals lithium en valproate, blijkt ook effectief te kunnen zijn bij pathologische gokkers zonder comorbide bipolaire stoornis (enkelblind studie; Pallanti, Quercioli, Sood, & Hollander, 2002). Ook in een dubbelblind uitgevoerde placebogecontroleerde studie met lithium bij pathologische gokkers met een bipolaire stoornis bleek deze medicatie effectief (Hollander, Pallanti, Allen, Sood, & BaldiniRossi, 2005a).…”

Pathological Gambling

“…30 Neuropsychological studies of subjects with PG 31,32 have demonstrated that these individuals have deficits in the frontal lobe/reward system, and we hypothesize that impairment of executive function may play an important role in the impulsive subtype of pathological gambler. These patients may respond best to medications such as bupropion 33,34 or mood stabilizers, 34 which are thought to target impulsive behavior. In the OC subtype of PG, we propose that there is a preponderance of female patients who tend to have the onset of symptoms in mid-life.…”

“…Pallanti et al 34 describe a connection between the clinical features of PG and bipolar disorder. They discuss characteristics common to both disorders, such as impulsive risk-taking behavior, mood swings, poor judgment, and grandiose thinking.…”

Compulsive disorders

“…Although studies have found positive results with a number of mood stabilizers, including lithium, carbemazepine, and valproic acid, a recent review article cautioned that many of these studies used unclear methodology or had small sample sizes. However, one study reported that several patients who had been treatment refractory to selective serotonin reuptake inhibitor (SSRI) therapy improved on a mood stabilizer [12], and a 14-week controlled trial showed significant improvement in pathologic gamblers treated with lithium and valproate [13].…”