A RARE ADVERSE EFFECT RELATED TO ARIPIPRAZOLE: GAMBLING DISORDER

TPD 25. Yıllık Toplantısı ve Klinik Eğitim Sempozyumu, İzmir, Turkey, 19 - 22 May 2022, vol.33, pp.66, (Summary Text)

Publication Type: Conference Paper / Summary Text
Volume: 33
City: İzmir
Country: Turkey
Page Numbers: pp.66
Ankara University Affiliated: Yes

Abstract

A RARE ADVERSE EFFECT RELATED TO ARIPIPRAZOLE: GAMBLING DISORDER Koray Hamza Cihan, Bora Baskak Department of Psychiatry, Ankara University, Ankara, Turkey OBJECTIVE: Aripiprazole is a second-generation antipsychotic with partial agonistic properties at the dopamine D2 and D3 receptors and is indicated in treatment of schizophrenia and bipolar disorder. It is assumed that aripiprazole plays a role in pathological gambling because it produces a hyperdopaminergic state via its’ agonistic properties at D3 receptors, which are predominantly located in the mesolimbic reward pathway. Here, we present a case with gambling disorder with particular onset after use of aripiprazole. Verbal consent was obtained from our patient for the case report. CASE: A 34-year-old male patient admitted to Ankara University Faculty of Medicine Psychiatry Department in September 2021 with complaints of increased urges for gambling (online soccer bets and horseracing). The patient was diagnosed as social anxiety disorder in adolescence and experienced numerous depressive episodes then after. He was prescribed aripiprazole 5 mg/day as an augmentation treatment of a depressive episode in summer 2018. During the follow-ups, the dose of aripiprazole was increased up to 20 mg/day in summer of 2019. 6 months after the initiation of aripiprazole treatment, he made a bet with 1000₺, which was the largest amount he had ever played. Then, for 2 years, he spent a total of 200,000₺ on betting and horse racing games. The amount of money he spent for bets increased in line with the increasing dose of aripiprazole. We immediately decreased aripiprazole gradually and aripiprazole was discontinued in two weeks. He wasn't gambling at his control in October 2021, but he still had the will and urge to play. In January 2022, however, he was not gambling and his desire and impulse to play had completely disappeared. South Oaks Gambling Screening Test (SOGST) (cut-off score: 8) and Gambling Disorder Screening Test (GDST) (cut-off score: 4) were administered before and after discontinuation of aripiprazole. Initial scores of SOGST and GDST were 13 and 8 respectively. Both scores dropped to zero in January 2022. DISCUSSION: The FDA Adverse Effects Reporting Database (20022012) reviewed the reports of 184 cases regarding a possible association between aripiprazole and impulse control problems and reported that 164 (89%) of the reported cases were pathological gambling. Aripiprazole’s SmPC indicates that patients can experience increased urges, particularly for gambling, and the inability to control these urges while taking aripiprazole. The presented case already had a history of playing low money bets, albeit rarely, since adolescence. The amount of bets increased significantly after the initiation of aripiprazole treatment -in line with increasing doses of the drug- reminding a possible doseresponse association. Complete recovery after cessation of aripiprazole is noteworthy. We would like to emphasize; (i) the importance of questioning not only the new onset gambling disorder but an increase in the amount spent after the initiation of aripiprazole treatment and (ii) the need for laboratory research to seek for a possible dose-response association between aripiprazole serum levels and gambling urges. Keywords: Aripiprazole, Partial Agonist, Pathological Gambling