Impulse-control problems such as gambling, increased spending, hypersexuality, and compulsive eating are thought to be influenced by temperamental, genetic, and physiological risk factors. In addition, dopamine receptor agonists have been implicated in some cases. It is postulated that aripiprazole may cause impulse-control problems because it can produce a hyperdopaminergic state in the mesolimbic pathway (reward system) through its predominant action on dopamine D3 receptors. We present the case of a patient with bipolar disorder and previous gambling behavior, in whom the gambling behavior escalated with the introduction of aripiprazole and its upward titration. The patient’s gambling problems were alleviated with a decrease in aripiprazole dosage. Clinicians should be vigilant for possible gambling and other impulse-control behaviors in patients taking aripiprazole. Our literature review suggests cariprazine and brexpiprazole, which have mechanisms of action similar to that of aripiprazole, may also be associated with possible risks of impulse-control problems and pathologic gambling.
GIRI: Department of Psychiatry, Psychiatric Neuro Center, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
PETERU: Department of Psychiatry, Consultation and Liaison Services, Jamaica Hospital Medical Center, Richmond Hill, NY
The authors declare no conflicts of interest.
Please send correspondence to: Yam R. Giri, MD, Department of Psychiatry, Psychiatric Neuro Center, Northwell Health, The Zucker Hillside Hospital, 7559 263rd St., Glen Oaks, NY 11004 (e-mails: email@example.com; firstname.lastname@example.org).