Olanzapine in the Treatment of Pathological Gambling: A Negative Randomized Placebo-Controlled Trial
J Clin Psychiatry 2008;69(3):433-440
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Pathological gambling is associated with bipolar
disorder and dopamine dysfunction. Olanzapine is a second-generation
antipsychotic with mood-stabilizing properties and antagonistic activity at
several dopamine receptors. The purpose of this study was to evaluate
olanzapine in the treatment of pathological gambling.
Method: In this 12-week, single-center, randomized,
double-blind, placebo-controlled, flexible-dose (2.5-15 mg/day) trial, 42
outpatients with pathological gambling by DSM-IV-TR criteria received
olanzapine (N = 21) or placebo (N = 21). The primary outcome measure was the
Pathological Gambling Adaptation of the Yale-Brown Obsessive Compulsive Scale (PG-YBOCS).
The primary analysis of efficacy was a longitudinal analysis of the
intent-to-treat sample, with treatment-by-time interaction as the effect
measure. Subjects were enrolled from June 2, 2000, through November 28, 2005.
Results: Compared with placebo, olanzapine was associated with
a similar rate of reduction in total scores on the PG-YBOCS scale, as well as
in gambling episodes/week, hours gambled/week, and Clinical Global
Impressions-Severity of Illness scale scores. The mean (SD) olanzapine daily
dose at endpoint evaluation was 8.9 (5.2) mg/day. Eleven subjects (52%)
receiving olanzapine and 6 (29%) receiving placebo discontinued prematurely; 3
subjects receiving olanzapine and 2 receiving placebo discontinued because of
adverse events. Events causing olanzapine discontinuation were pneumonia,
sedation, and hypomania.
Conclusion: Olanzapine was not superior to placebo in the
short-term treatment of pathological gambling. It was also associated with a
high discontinuation rate.