Table 2.

Randomized, Placebo-controlled, Double-blind Drug Trials in the Treatment of Pathological Gambling

Category	Reference	Drug	Sample Size	Duration	Average EOS Active Dose mg/d (±SD)	Outcome
Selective serotonin reuptake inhibitors (SSRIs)	Hollander et al., 200089	Fluvoxamine (Luvox)	15 Subjects enrolled, 10 completed	16-wk (crossover design, 8 wk each of active/placebo) with initial 1-wk placebo lead-in	195 (±50)	7 of 10 completers determined to be responders by PG-CGI and PG-YBOCS scores; Fluvoxamine superior to placebo, particularly at end of 16 wk of treatment
	Kim et al., in press90	Paroxetine (Paxil)	53 Subjects enrolled, 45 randomized, 41 completed (20 paroxetine, 21 placebo)	8-wk, parallel design, with 1-wk placebo lead-in	52 (±13)	Paroxetine group significantly improved as compared with placebo as determined by CGI, G-SAS
Opioid antagonists	Kim et al., 200191	Naltrexone (ReVia)	89 Subjects enrolled, 45 completed (20 naltrexone, 25 placebo)	12-wk parallel design, with 1-wk placebo lead-in	188 (±96)	Naltrexone group significantly improved as compared with Placebo as determined by CGI, G-SAS; risk of LFT abnormalities with analgesics
Mood stabilizers	Hollander et al., 200192	Sustained-release lithium (Lithobid)	37 Bipolar-spectrum subjects enrolled, 26 completed (10 lithium, 16 Placebo)	10-wk, parallel design	1,170 (±221)	Lithium group significantly improved as compared with Placebo as determined by PG-CGI, PG-YBOCS and CARS-M scores; 9/10 lithium-treated completers rated as responders
Antipsychotics	Rugle et al., 200193	Olanzapine (Zyprexa)	23 Video-poker gamblers enrolled, 21 completed (9 olanzapine, 12 placebo)	7-wk, parallel design (nonflexible, escalating dosing strategy)	10 (±0)	No significant between-group drug effect differences found on measures of changes in gambling urges (GCS) or behavior (Glog)

EOS, end-of-study; SD, standard deviation; mg/d, milligrams per day; PG-CGI, Clinical Global Impression Scale for Gambling Behavior; PG-YBOCS, Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling; CGI, Clinical Global Impression Scale; G-SAS, Gambling Symptom Assessment Scale; LFT, liver function test; CARS-M, Clinician-Administered Rating Scale for Mania; GCS, Gambling Craving Scale; Glog, daily gambling behavior log.

Modified and reprinted with permission from the chapter “Pathological gambling: clinical aspects and neurobiology” in the forthcoming book Handbook of Medical Psychiatry by courtesy of Marcel Dekker, Inc.¹⁰³