Aripiprazole Induced Gambling, in Patients with Learning Disabilities

In this paper we explore the potential association between aripiprazole—a partial dopamine agonist and gambling. In December 2023, The Medicines and Healthcare Products Regulatory Agency (MHRA) issued a drug safety alert, highlighting an increasing number of yellow card reports, linking the use of Aripiprazole with impulse control disorders, such as gambling, hypersexuality, increased spending and binge eating. Aripiprazole exerts its therapeutic effects via partial agonistic activity at dopaminergic and serotonergic receptors, particularly within the mesolimbic pathway, commonly referred to as the brain’s “reward pathway”. It has been hypothesised that partial agonism at the D2 and D3 receptors within these pathways may contribute to the emergence of impulse control disorders in susceptible individuals, although the precise mechanisms remain poorly understood. We reviewed the available literature linking aripiprazole to impulse control disorders and case reports where individuals being treated with this therapeutic agent had either developed or exacerbated existing gambling behaviours, in addition to reviewing 2 cases on the Community Forensic teams (CFT) caseload where patients were exhibiting similar patterns of either excessive or problematic gambling behaviours following initiation of aripiprazole. As a literature review, searches of PubMed, Embase, CINHAL (Ebsco) and Google Scholar were undertaken using the terms “aripiprazole”, “gambling”, “impulse control disorder” “D2 receptors”, “D3 receptors”, “mesolimbic system”, “reward pathway” and “pathological gambling”. English-language publications available up to January 2024 were reviewed. Our findings from searching the existing literature, media reports and our own caseload do find a temporal correlation between problematic gambling and aripiprazole use. The severity of this varies between affected individuals, however; the MHRA update further corroborates this link. We suggest further research into the mechanisms of action of aripiprazole on mesolimbic system is required to gain a better understanding of why this psychotropic medication appears to potentially upregulate the rewards pathway, and what underlying inherent and environmental factors predispose some individuals to develop impulse control disorders and not others. Review of our clinical caseload demonstrated a temporal association between aripiprazole treatment and the emergence or worsening of gambling behaviours in