The pharmacological management of gambling disorder: if, when, and how

Introduction Gambling disorder (GD) consists in a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment. The aetiology of GD is multifactorial. GD frequently co-occurs with other psychiatric disorders, and is often untreated. Different psychosocial interventions, particularly cognitive-behavioural therapy are useful in the treatment of GD. Also pharmacological therapy may be helpful for the treatment of GD. No formal guidelines exist, and the management of the disease is often guided by few clinical elements. Areas covered A literature search was performed using PubMed, Scopus and Web of Science databases about treatment options for GD, considering both psychosocial treatments and available pharmacological ones. Expert opinion The authors address the question of whether and when it is appropriate to initiate pharmacological treatment for GD. They focus on providing clinicians with guidance on how to approach patients with GD in those situations where pharmacological therapy may be necessary. The reasons for the clinician to start thinking about a medication are examined. As specific traits in the psychopathology of GD may be managed with a strategic choice of the pharmacologic agent, the different available options are analyzed on the basis of their potential usefulness in GD. Issues that remain open about the pharmacological management of GD are summarized.