12-month follow-up study of drug treatment in pathological gamblers: a primary outcome study.
BACKGROUND
Pathological gambling (PG) is a relatively common and highly disabling impulse control disorder. A range of psychotherapeutic agents including selective serotonin reuptake inhibitors, antiepileptic drugs, and opioid antagonists are shown to be effective in the short-term treatment of PG. The use of a wide range of pharmacological treatments for PG is consistent with the observation that PG shares features of obsessive-compulsive spectrum disorders, impulse control disorders, and addictive disorders. The aim of the study is to assess the rate of relapse in treatment-responder pathological gamblers after discontinuation of the active treatment.


METHODS
Our study sample was composed of 43 male pathological gamblers who had been full responders to 1 of 4 drug treatment regimens (fluvoxamine, topiramate, bupropion SR, or naltrexone) from several previous acute open-label (12-week) comparison studies. Full response was defined as the absence of gambling for a 1-month duration together with improvement on the Clinical Global Improvement scale. The 43 full responders were then followed prospectively for an additional 9 months, which included a 3-month open-label continuation phase and a 6-month medication-free follow-up phase. Follow-up visits were performed on a monthly basis throughout the duration of study. At every follow-up visit, a comprehensive psychiatric diagnostic evaluation was performed on all patients, and patients were assessed for symptoms of gambling using a self-report instrument and collateral family reports. The Clinical Global Impression Improvement scale was also administered at every follow-up visit. Raters were blind to the previous drug treatment.


RESULTS
Most patients did not relapse during the 6-month medication-free follow-up phase. Three of 6 patients with fluvoxamine, 3 of 9 with topiramate, 7 of 18 with bupropion SR, and 4 of 10 with naltrexone relapsed. Relapse was strictly defined as gambling behavior at any time during the 6-month medication-free follow-up period. Most of the patients did not gamble during the follow-up period, and the patients that did gamble reported a decrease in gambling losses.


CONCLUSIONS
This naturalistic long-term follow-up outcome study demonstrates that among pathological gamblers who respond to a 6-month trial of medication, most patients seem to maintain full-response during a 6-month medication-free follow-up phase. Further studies are needed to confirm our findings.
Dannon
Pinhas N
PN
Tel Aviv University, Tel Aviv, Israel. pinhasd@post.tau.ac.il
Lowengrub
Katherine
K
Musin
Ernest
E
Gonopolsky
Yehudit
Y
Kotler
Moshe
M
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016642:Bupropion / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D004358:Drug Therapy / Q000379:methods*; D016666:Fluvoxamine / Q000627:therapeutic use; D005500:Follow-Up Studies; D005632:Fructose / Q000031:analogs & derivatives / Q000627:therapeutic use; D005715:Gambling / Q000523:psychology*; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011600:Psychopharmacology / Q000379:methods; D012008:Recurrence; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors; D000077236:Topiramate
D003692:Delayed-Action Preparations; D016642:Bupropion; D000077236:Topiramate; D005632:Fructose; D009271:Naltrexone; D016666:Fluvoxamine