Topiramate Versus Fluvoxamine in the Treatment of Pathological Gambling

Abstract

Pathologic gambling (PG) is a highly prevalent and disabling impulse control disorder. Recent studies have demonstrated that PG patients respond well to treatment with SSRIs, mood stabilizers, and opioid antagonists. These findings support the idea that PG and other disorders of impulse control may be conceptualized as part of the obsessive-compulsive spectrum disorders. Pilot studies have shown topiramate to be effective in the treatment of specific disorders of impulse control. The aim of the study is to compare the effectiveness of topiramate versus fluvoxamine in the treatment of PG. Thirty-one male PGs were assigned in a randomized fashion to receive either topiramate (15/31) or fluvoxamine (16/31) pharmacotherapy for 12 weeks. A comprehensive psychiatric diagnostic evaluation was performed on all patients, and all patients were evaluated for symptoms of gambling, depression, and anxiety using the South Oaks Gambling Screen, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Yale-Brown Obsessive Compulsive Symptoms Scale, and the Clinical Global Impression-Improvement Scale. The rating scales were administered at baseline and at the 12-week endpoint. In addition, the patients completed self-report questionnaires about their demographic status. Twelve of the 15 patients from the topiramate group completed the 12-week treatment. Nine of the 12 topiramate completers reported full remission of gambling behavior, and 3 completers had a partial remission. The CGI-improvement score was significantly better for the topiramate group at the 12-week visit as compared with baseline (F = 10.5, P < 0.01, df = 2.31). In the fluvoxamine treatment group 8/16 patients completed the study, and 6/8 fluvoxamine completers reported a full remission, and the remaining 2/8 fluvoxamine completers reported a partial remission. The fluvoxamine group showed improvement in the CGI-improvement score at week 12, although this difference was not significant (F = 3.7, P < 0.08, df = 2.31). Topiramate and fluvoxamine monotherapy may be effective in the treatment of pathologic gambling.

Topiramate-induced weight loss is possibly due to the blockade of conditioned and automatic processes

“…This observation is in line with observations on topiramate's effects on various addictive and/or compulsive behaviors such as alcohol addiction [6], nicotine addiction [7], sexual compulsive behavior [8], pathological gambling [9] as well as binge-eating disorder [10]. It could be of high interest to investigate the importance of automatic and conditioned processes in overeating in obese patients who probably could have better response to topiramate treatment.…”

Drinkers and bettors: Investigating the complementarity of alcohol consumption and problem gambling

“…Others have investigated the effectiveness of various prevention (Ferland et al, 2005) and treatment (Dannon et al, 2005;Saiz-Ruiz et al, 2005) programs. One potential risk factor for problematic gambling is alcohol use, but past studies of this relationship have not addressed the potential endogeneity of alcohol use in the gambling equations and/or had minimal generalizability.…”

Psychiatric uses of topiramate: What is the current evidence?

“…36 This study was small and of relatively short duration. In a small case series of 3 kleptomanic patients, it was reported that subjects responded well to topiramate given either alone or in combination with an SSRI.…”