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Assistant Professor, Department of Psychiatry, University of Nebraska Medical Center and the Omaha Veterans, Affairs Medical Center, 4101 Woolworth Avenue, Omaha, Nebraska 68105, fax 402/943-5543, ppadala{at}unmc.edu
House Officer III, Creighton-Nebraska Psychiatry Program, Omaha, Nebraska
Assistant Professor, Department of Psychiatry, Creighton University and the Omaha Veterans Affairs Medical Center
Published Online, March 6, 2007. www.theannals.com, DOI 10.1345/aph.1H311
Case Report. A 61-year-old white male with a 40 year history of pathological gambling had a cumulative loss of $400 000. His medical history and concomitant medications were noncontributory. His history was suggestive of preoccupation, loss of control, preference for gambling over other activities, and several failed attempts to quit. His depression had been treated with citalopram 4 years previously, and he reported improvement in depression but no change in gambling habits.
He had formerly received treatment without drugs 3 times with mixed results in a 30 day outpatient program tailored for gambling. He relapsed following the last 2 programs after 3 and 4 months of abstinence, respectively. Immediately after completing his third 30 day outpatient program, he was treated with bupropion SR 100 mg twice daily. He remained abstinent from gambling and nicotine for the next 8 months. He presented to our clinic 3 weeks after he had used all of his bupropion, reporting an increase in craving for gambling and nicotine for the past 2 weeks. After being restarted on bupropion SR at the previous dose, he experienced a prompt reduction in cravings.
In addition to the resumption of the medication, psychosocial interventions were initiated. The patient's credit card debts were consolidated into a low-interest loan, and his family was asked to support him by providing calling cards, bus tickets, and groceries instead of money. He has continued to abstain from gambling and nicotine for more than a year and a half.
Discussion. Bupropion is an aminoketone structurally related to diethylpropion. It selectively inhibits the reuptake of dopamine in several areas of the brain, including the nucleus accumbens, which may play a role in decreasing urges, craving, and a sense of enjoyment seen in pathological gambling.4
Bupropion's role in treating pathological gambling has been investigated in 2 studies. It was shown to be effective in an 8 week open-label study of 10 adults5 and, after completion of a 12 week trial, 9 of 12 patients who received bupropion SR were rated as full responders.4
Our patient tolerated bupropion, and its use helped in resolution of gambling and nicotine. With only 3- and 4-month abstinence periods after the first 2 treatment programs and, at time of writing, abstinence of more than 18 months after the addition of bupropion, some of the response may be attributed to the addition of bupropion. However, caution needs to be observed when attributing the success entirely to the use of bupropion. Our patient's response may have been aided by the carryover effect of the treatment programs, the family involvement, and psychosocial interventions.
References
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