Amantadine in the Treatment of Pathological Gambling: A Case Report

Mauro Pettorruso,Gianluigi Conte,Giovanni Martinotti,Massimo Di Giannantonio,Luigi Janiri,Marco Di Nicola,Marco Onofrj

doi:10.3389/fpsyt.2012.00102

Abstract

Despite almost a decade of intense research, effective treatment strategies for Pathological Gambling (PG) remain very challenging. This paper details a case report suggesting that the treatment of PG may benefit from the use of the non-specific glutamate blocker amantadine. The drug was well-tolerated and effective, leading to a 43–64% reduction in severity of gambling symptoms (as measured with G-SAS). Our result is discussed in the context of the glutamatergic hypothesis of addiction and in light of previous observations on the potential impact of glutamatergic agents in the treatment of PG. The role of the dopaminergic system, and its interaction with the glutamatergic system, is also explored. Further studies are required to define the true benefits of amantadine for the treatment of PG.

Highlights

Pathological gambling (PG) is characterized by persistent and maladaptive gambling behavior, whereby individuals engage in frequent and repeated episodes of gambling despite serious adverse consequences (Hodgins et al, 2011)
Besides its established use in the treatment of levodopa-induced dyskinesia (Pappa et al, 2010; Sawada et al, 2010), amantadine has recently been studied in Parkinson’s disease (PD) patients as an additional treatment option for punding and PG (Thomas et al, 2010), in light of the hypothesis that both dyskinesias and compulsive behaviors represent part of a pathological continuum secondary to abnormal dopaminergic stimulation in the basal ganglia (Voon et al, 2009)
CONCLUDING REMARKS Our data seem to confirm the utility of targeting the Glu system for the treatment of PG, and suggest that the non-specific Glu blocker amantadine may possibly be a viable treatment option

Summary

Introduction

Pathological gambling (PG) is characterized by persistent and maladaptive gambling behavior, whereby individuals engage in frequent and repeated episodes of gambling despite serious adverse consequences (Hodgins et al, 2011). Gambling disorder affects 0.2–5.3% of adults worldwide; the devastating consequences of this behavioral disturbance often entail severe damage to the lives of patients and their families. It has been proposed that PG be included in the diagnostic category of Substance Use and Addictive Disorders of the edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V; Petry, 2010). It has been recently proposed that addiction be viewed as the result of an impaired ability to inhibit drug seeking in response to environmental contingencies, due to alterations in glutamate (Glu) homeostasis, with combined activation of sensitized dopamine (DA) and N -methyl-d-aspartate (NMDA) glutamatergic receptors (Kalivas, 2009)

Findings

Discussion

Conclusion