Tratamentul farmacologic bazat pe dovezi al dependenţei de jocuri de noroc

Pathological gambling is a diagnostic undergoing continuous reassessment, being considered an impulse-control disorder, a behavioral addiction assimilated with a substance-related disorder, or even a disorder from the obsessive-compulsive spectrum. The neurobiology of this pathology is complex, with dysfunctions of the dopaminergic, serotonergic, noradrenergic, opioidergic, glutamatergic and GABA-ergic systems, which involve the amygdala, striatum, prefrontal cortex etc. The main classes of pharmacological agents studied for the therapy of gambling addiction are antidepressants, mood stabilizers and opioid receptor antagonists. In addition, a variety of other agents have been investigated, with controversial results, from psychostimulants like modafinil to glutamatergic agents like amantadine, and from disulfiram to GABA-ergic modulators such as baclofen. What is certain is that, so far, no drug has been approved at the European or worldwide level by a pharmaceutical regulatory authority for the treatment of pathological gambling. Therefore, the therapeutic guidelines warn about the need to inform the patient that the medication offered is used off-label and about the need to combine pharmacotherapy with other types of treatment that have a higher level of evidence, such as cognitive-behavioral therapy.