Partial Dopamine Agonists and Gambling Disorder: A Comprehensive Review and Clinical Implications.

PURPOSE: Aripiprazole, cariprazine, and brexpiprazole are third-generation antipsychotics indicated for the treatment of various mental health conditions. Several cases of gambling-related harms and various impulse control problems related to aripiprazole have been reported. The objective of our study was to conduct a comprehensive review focusing on case reports about gambling disorder induced by partial dopamine agonist therapy.

PROCEDURES: A multistep literature search in different databases was carried out. Articles were screened by title and then by abstract for inclusion in data extraction. Articles were included if they were: (1) providing data about gambling behaviour induced by a partial dopamine agonist, (2) case reports or case series, and (3) written in English.

FINDINGS: Seventeen articles were eligible for data extraction, for a total of 36 patients. All the case reports were related to aripiprazole, while no case studies reporting gambling induced by brexpiprazole and cariprazine were found. The mean age of the total sample was 35.1 years (range: 17 to 64). The main psychiatric comorbidities were schizophrenia (N = 15, 41.6%), followed by bipolar disorder (N = 7, 19.4%). In most of the cases, it was necessary to suspend aripiprazole, with a good outcome on gambling disorder (N = 24, 66.6%).

IMPLICATIONS: The data presented suggest a clear relationship between aripiprazole and gambling behaviour, although more research is needed on this topic. Clinicians should be aware of the risk of gambling associated with partial dopamine agonists, and should therefore monitor the occurrence of gambling behaviour when introducing this drug, because patients may be reluctant to disclose it voluntarily.