Rosenberg Oded, Dinur Limor Klein, Dannon Pinhas N
Beer Yaakov Mental Health Center affiliated to the Sackler School of Medicine, University of Tel Aviv, Israel.
Clin Neuropharmacol. 2013 Mar-Apr;36(2):42-5. doi: 10.1097/WNF.0b013e31828740ea.
In the past decade, we have witnessed the emergence of pharmacological treatments for pathological gambling with some success but many question marks. We aimed to explore pharmacological treatments that have been previously explored with some success, with the intent of comparing their efficacy and pave the way to larger placebo-controlled trials.
In this study, we allocated 78 patients to 4 different types of psychotropic medications: naltrexone, topiramate, bupropion, and escitalopram. We treated patients for more than 2 years, with additional 2-year follow-ups without medication. The sample was evaluated using the 21-item Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Global Assessment of Functioning, and the Visual Analog Scale to measure general well-being before enrollment as well as at 1 month, 6 months, 24 months, and 48 months after beginning medication treatment.
During the first 2 years of treatment, 34 patients dropped out, with one more dropping out during the additional 2 years of follow-up. Significant improvement on all rating scales was seen in all groups after 2 years, except HAMD in the group that received topiramate. We found the naltrexone-treated group of patients to have a statistically significant lower dropout rate compared with other groups, statistically significant lower HAMD scores in comparison to the group treated with bupropion, statistically significant lower Hamilton Anxiety Rating Scale score compared to the groups treated with escitalopram and topiramate, and significantly higher Visual Analog Scale scores compared to the groups treated with bupropion and topiramate.
Pathological gambling is essentially a biopsychological disorder that may be attenuated provided that patients adhere to medication. In our study, among 4 medications with different mechanisms of action, naltrexone was found to be the most effective. Placebo-controlled studies involving large numbers of subjects are required before naltrexone's efficacy can be established.
在过去十年中，我们见证了针对病理性赌博的药物治疗的出现，虽取得了一些成功，但也存在诸多疑问。我们旨在探索此前已取得一定成功的药物治疗方法，以便比较它们的疗效，并为更大规模的安慰剂对照试验铺平道路。
在本研究中，我们将78名患者分配至4种不同类型的精神药物治疗组：纳曲酮、托吡酯、安非他酮和艾司西酞普兰。我们对患者进行了超过2年的治疗，并在之后进行了2年的无药物随访。在入组前以及开始药物治疗后的1个月、6个月、24个月和48个月，使用21项汉密尔顿抑郁量表、汉密尔顿焦虑量表、功能总体评定量表和视觉模拟量表对样本进行评估，以测量总体幸福感。
在治疗的前2年，有34名患者退出，在随后的2年随访中又有1名患者退出。2年后，除接受托吡酯治疗的组的汉密尔顿抑郁量表评分外，所有组在所有评定量表上均有显著改善。我们发现，与其他组相比，接受纳曲酮治疗的患者组的退出率在统计学上显著更低；与接受安非他酮治疗的组相比，接受纳曲酮治疗的组的汉密尔顿抑郁量表评分在统计学上显著更低；与接受艾司西酞普兰和托吡酯治疗的组相比，接受纳曲酮治疗的组的汉密尔顿焦虑量表评分在统计学上显著更低；与接受安非他酮和托吡酯治疗的组相比，接受纳曲酮治疗的组的视觉模拟量表评分显著更高。
病理性赌博本质上是一种生物心理障碍，只要患者坚持用药，病情可能会得到缓解。在我们的研究中，在4种具有不同作用机制的药物中，纳曲酮被发现是最有效的。在确定纳曲酮的疗效之前，需要进行涉及大量受试者的安慰剂对照研究。
