Skip to main content
SpringerLink
Log in

Citalopram-Associated Gambling: A Case Report

  • Original Paper
  • Published:
Journal of Gambling Studies Aims and scope Submit manuscript

Abstract

Pathological gambling behaviour is a side effect of dopaminergic drugs used in Parkinson’s disease, but has seldom been reported with selective serotonin reuptake inhibitors. A 58-years-old woman with somatisation disorder since the age of 20 and recent-onset major depression (at 54 years) received 40 mg/day intravenous citalopram, thereafter switching to the same dose of oral citalopram to treat her comorbid psychiatric disorders after showing poor response to paroxetine for one year. Her anxious and depressive symptoms were moderately reduced after 7 months of oral citalopram, but simultaneously, the patient admitted gambling. We gradually discontinued citalopram and introduced pregabalin and alprazolam; this was followed by a reduction of gambling compulsions, but the somatisation and depressive symptoms did not further improve. Pathological gambling may be mediated by an interplay of 5-HT1A serotonergic and D2 dopaminergic mechanisms. Citalopram affects both these mechanisms in areas that were shown to be involved in gambling behaviour, but while dopaminergic effects of citalopram appear to be consistent with the induction of gambling, its serotonergic mechanisms are rather inconsistent. In our patient, mood destabilisation induced by citalopram may have contributed to the first onset of pathological gambling.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th edition-text revision (DSM-IV-TR). Washington, D.C.: American Psychiatric Association.

    Book  Google Scholar 

  • Arnt, J., Overø, K. F., Hyttel, J., & Olsen, R. (1984). Changes in rat dopamine- and serotonin function in vivo after prolonged administration of the specific 5-HT uptake inhibitor, citalopram. Psychopharmacology (Berlin), 84(4), 457–465.

    Article  CAS  Google Scholar 

  • Bari, A., Theobald, D. E., Caprioli, D., Mar, A. C., Aidoo-Micah, A., Dalley, J. W., et al. (2010). Serotonin modulates sensitivity to reward and negative feedback in a probabilistic reversal learning task in rats. Neuropsychopharmacology, 35(6), 1290–1301.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Bijak, M., & Smiałowski, A. (1988). The effect of acute and prolonged treatment with citalopram on the action of dopamine and SKF 38393 in rat hippocampal slices. European Journal of Pharmacology, 149(1–2), 41–47.

    Article  CAS  PubMed  Google Scholar 

  • Black, D. W., Shaw, M., Forbush, K. T., & Allen, J. (2007). An open-label trial of escitalopram in the treatment of pathological gambling. Clinical Neuropharmacology, 30(4), 206–212.

    PubMed  Google Scholar 

  • Bobula, B., Tokarski, K., Zahorodna, A., & Hess, G. (2003). Adaptive changes in the reactivity of 5-HT1A and 5-HT2 receptors induced in rat frontal cortex by repeated imipramine and citalopram. Naunyn-Schmiedeberg’s Archives of Pharmacology, 367(5), 444–450.

    Article  CAS  PubMed  Google Scholar 

  • Boughton, R., & Falenchuk, O. (2007). Vulnerability and comorbidity factors of female problem gambling. Journal of Gambling Studies, 23(3), 323–334.

    Article  PubMed  Google Scholar 

  • Campbell-Meiklejohn, D., Wakeley, J., Herbert, V., Cook, J., Scollo, P., Ray, M. K., et al. (2011). Serotonin and dopamine play complementary roles in gambling to recover losses. Neuropsychopharmacology, 36(2), 402–410.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Ceglia, I., Acconcia, S., Fracasso, C., Colovic, M., Caccia, S., & Invernizzi, R. W. (2004). Effects of chronic treatment with escitalopram or citalopram on extracellular 5-HT in the prefrontal cortex of rats: Role of 5-HT1A receptors. British Journal of Pharmacology, 142(3), 469–478.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Chamberlain, S. R., Müller, U., Blackwell, A. D., Clark, L., Robbins, T. W., & Sahakian, B. J. (2006). Neurochemical modulation of response inhibition and probabilistic learning in humans. Science, 311(5762), 861–863.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Erbas, B., & Buchner, U. G. (2012). Pathological gambling: Prevalence, diagnosis, comorbidity, and intervention in Germany. Deutsches Ärzteblatt International, 109(10), 173–179.

    PubMed Central  PubMed  Google Scholar 

  • Ghaemi, S. N. (2008). Treatment of rapid-cycling bipolar disorder: Are antidepressants mood destabilizers? American Journal of Psychiatry, 165(3), 300–302.

    Article  PubMed  Google Scholar 

  • Grant, J. E., & Kim, S. W. (2005). Quality of life in kleptomania and pathological gambling. Comprehensive Psychiatry, 46(1), 34–37.

    Article  PubMed  Google Scholar 

  • Grant, J. E., & Potenza, M. N. (2006). Escitalopram treatment of pathological gambling with co-occurring anxiety: An open-label pilot study with double-blind discontinuation. International Clinical Psychopharmacology, 21(4), 203–209.

    Article  PubMed  Google Scholar 

  • Hollander, E., Buchsbaum, M. S., Haznedar, M. M., Berenguer, J., Berlin, H. A., Chaplin, W., et al. (2008). FDG-PET study in pathological gamblers. 1. Lithium increases orbitofrontal, dorsolateral and cingulate metabolism. Neuropsychobiology, 58(1), 37–47.

    Article  PubMed  Google Scholar 

  • Hosokawa, T., Momose, T., & Kasai, K. (2009). Brain glucose metabolism difference between bipolar and unipolar mood disorders in depressed and euthymic states. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 33(2), 243–250.

    Article  CAS  PubMed  Google Scholar 

  • Hu, S., & Li, C. S. (2012). Neural processes of preparatory control for stop signal inhibition. Human Brain Mapping, 33, 2785–2796.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., et al. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38(9), 1351–1360.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Macoveanu, J., Rowe, J.B., Hornboll, B., Elliott, R., Paulson, O.B., Knudsen, G.M., & Siebner, H.R. (2012). Playing it safe but losing anyway–Serotonergic signaling of negative outcomes in dorsomedial prefrontal cortex in the context of risk-aversion. European Neuropsychopharmacology, 2012 Oct 7. doi:10.1016/j.euroneuro.2012.09.006.

  • Maj, J., Dziedzicka-Wasylewska, M., Rogoz, R., & Rogóz, Z. (1998). Effect of antidepressant drugs administered repeatedly on the dopamine D3 receptors in the rat brain. European Journal of Pharmacology, 351(1), 31–37.

    Article  CAS  PubMed  Google Scholar 

  • Marazziti, D., Golia, F., Picchetti, M., Pioli, E., Mannari, P., Lenzi, F., et al. (2008). Decreased density of the platelet serotonin transporter in pathological gamblers. Neuropsychobiology, 57(1–2), 38–43.

    Article  CAS  PubMed  Google Scholar 

  • Moulin-Sallanon, M., Charnay, Y., Ginovart, N., Perret, P., Lanfumey, L., Hamon, M., et al. (2009). Acute and chronic effects of citalopram on 5-HT1A receptor-labeling by [18F] MPPF and—coupling to receptors-G proteins. Synapse (New York, N. Y.), 63(2), 106–116.

    Article  CAS  Google Scholar 

  • Naranjo, C. A., Busto, U., Sellers, E. M., Sandor, P., Ruiz, I., Roberts, E. A., et al. (1981). A method for estimating the probability of adverse drug reactions. Clinical Pharmacology and Therapeutics, 30(2), 239–245.

    Article  CAS  PubMed  Google Scholar 

  • Nordin, C., & Sjödin, I. (2005). Reduced free tri-iodothyronine serum levels are lower in pathological male gamblers than in healthy male controls. Journal of Psychiatric Research, 39(4), 449.

    Article  PubMed  Google Scholar 

  • Pallanti, S., Haznedar, M. M., Hollander, E., Licalzi, E. M., Bernardi, S., Newmark, R., et al. (2010). Basal ganglia activity in pathological gambling: A fluorodeoxyglucose-positron emission tomography study. Neuropsychobiology, 62(2), 132–138.

    Article  PubMed  Google Scholar 

  • Potenza, M. N. (2008). Review. The neurobiology of pathological gambling and drug addiction: An overview and new findings. Philosophical Transactions of the Royal Society London B. Biological Sciences, 363(1507), 3181–3189.

    Article  Google Scholar 

  • Pozzi, L., Invernizzi, R., Garavaglia, C., & Samanin, R. (1999). Fluoxetine increases extracellular dopamine in the prefrontal cortex by a mechanism not dependent on serotonin: A comparison with citalopram. Journal of Neurochemistry, 73(3), 1051–1057.

    CAS  PubMed  Google Scholar 

  • Prisco, S., & Esposito, E. (1995). Differential effects of acute and chronic fluoxetine administration on the spontaneous activity of dopaminergic neurones in the ventral tegmental area. British Journal of Pharmacology, 116(2), 1923–1931.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Rogoz, R., & Dziedzicka-Wasylewska, M. (1999). Effects of antidepressant drugs on the dopamine D2/D3 receptors in the rat brain differentiated by agonist and antagonist binding—an autoradiographic analysis. Naunyn-Schmiedeberg’s Archives of Pharmacology, 359(3), 178–186.

    Article  CAS  PubMed  Google Scholar 

  • Sekine, Y., Suzuki, K., Ramachandran, P. V., Blackburn, T. P., & Ashby, C. R., Jr. (2007). Acute and repeated administration of fluoxetine, citalopram, and paroxetine significantly alters the activity of midbrain dopamine neurons in rats: An in vivo electrophysiological study. Synapse (New York, N. Y.), 61(2), 72–77.

    Article  CAS  Google Scholar 

  • Swick, D., Ashley, V., & Turken, U. (2011). Are the neural correlates of stopping and not going identical? Quantitative meta-analysis of two response inhibition tasks. Neuroimage, 56(3), 1655–1665.

    Article  PubMed  Google Scholar 

  • Vaidya, J. G., Block, R. I., O’Leary, D. S., Ponto, L. B., Ghoneim, M. M., & Bechara, A. (2012). Effects of chronic marijuana use on brain activity during monetary decision-making. Neuropsychopharmacology, 37(3), 618–629.

    Article  PubMed Central  PubMed  Google Scholar 

  • van Holst, R. J., van den Brink, W., Veltman, D. J., & Goudriaan, A. E. (2010a). Brain imaging studies in pathological gambling. Current Psychiatry Reports, 12(5), 418–425.

    Article  PubMed Central  PubMed  Google Scholar 

  • van Holst, R. J., van den Brink, W., Veltman, D. J., & Goudriaan, A. E. (2010b). Why gamblers fail to win: A review of cognitive and neuroimaging findings in pathological gambling. Neuroscience and Biobehavioral Reviews, 34(1), 87–107.

    Article  PubMed  Google Scholar 

  • Weikop, P., Yoshitake, T., & Kehr, J. (2007). Differential effects of adjunctive methylphenidate and citalopram on extracellular levels of serotonin, noradrenaline and dopamine in the rat brain. European Neuropsychopharmacology, 17(10), 658–671.

    Article  CAS  PubMed  Google Scholar 

  • Zeeb, F. D., Robbins, T. W., & Winstanley, C. A. (2009). Serotonergic and dopaminergic modulation of gambling behavior as assessed using a novel rat gambling task. Neuropsychopharmacology, 34(10), 2329–2343.

    Article  CAS  PubMed  Google Scholar 

  • Zimmerman, M., Breen, R. B., & Posternak, M. A. (2002). An open-label study of citalopram in the treatment of pathological gambling. Journal of Clinical Psychiatry, 63(1), 44–48.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We gratefully acknowledge the contribution of the Librarians of the School of Medicine and Psychology of Sapienza University, Ms. Mimma Ariano, Ms. Felicia Proietti and the late Ms. Tiziana Mattei, in helping us localising relevant literature.

Conflict of interest

Paolo Girardi in the past 12 months has participated in Advisory Boards for Springer Healthcare and received grants and payment for writing a manuscript from Springer Healthcare, Milan; Georgios D. Kotzalidis is the recipient of an Italian Ministry of Education Ph.D. Grant for Early Intervention in the Psychoses.

All other authors of this paper have no relevant affiliations or financial involvement with any organization or entity with a financial interest in, or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

Author information

Authors and Affiliations

  1. NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Unit of Psychiatry, School of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University, Via di Grottarossa 1035-1039, 00189, Rome, Italy

    Ilaria Cuomo, Georgios D. Kotzalidis, Federica Caccia, Emanuela Danese, Giovanni Manfredi & Paolo Girardi

Authors
  1. Ilaria Cuomo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georgios D. Kotzalidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federica Caccia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emanuela Danese
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giovanni Manfredi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paolo Girardi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilaria Cuomo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cuomo, I., Kotzalidis, G.D., Caccia, F. et al. Citalopram-Associated Gambling: A Case Report. J Gambl Stud 30, 467–473 (2014). https://doi.org/10.1007/s10899-013-9360-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10899-013-9360-2

Keywords

Search

Navigation