{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:25Z","timestamp":1787022085919,"version":"build-2736575974"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Gambling Disorder (GD) has recently been reclassified from an impulse-control disorder to a behavioural addiction and, as in other addictive disorders, the dopaminergic reward system is involved. According to neuroimaging studies, alterations within the striatal dopaminergic signalling can occur in GD. However, the findings to date are controversial and there has been no agreement yet on how the reward system is affected on a molecular basis. Within the last 20 years, there has been growing evidence for a higher risk to develop GD in response to certain dopaminergic medication. Especially the dopamine agonists pramipexole and ropinirole, and the dopamine modulator aripiprazole seem to increase the likelihood for GD. The goal of this study was to examine the association between a prescription for either of the three pharmaceuticals and a GD diagnosis in a large cross-sectional study of the Swedish population. Compared to patients with any other dopaminergic drug prescription (38.7% with GD), the diagnosis was more common in patients with a dopamine agonist prescription (69.8% with GD), resulting in an odds ratio of 3.2. A similar association was found between aripiprazole prescriptions and GD diagnoses, which were analysed within the subgroup of all patients with schizophrenia or a schizotypal, delusional, or another non-mood psychotic disorder. An aripiprazole prescription increased the likelihood of GD (88.8%) in comparison to patients without an aripiprazole prescription (71.2%) with an odds ratio of 3.4. This study contributes to the increasingly reliable evidence for an association between several dopaminergic drugs and a higher risk for developing GD. Therefore, one future research goal should be a better understanding of the neurobiology in GD to be able to design more selective dopaminergic medication with less severe side effects. Additionally, this knowledge could enable the development of pharmacotherapy in GD and other addictive disorders.<\/jats:p>","DOI":"10.1371\/journal.pone.0252516","type":"journal-article","created":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T14:44:10Z","timestamp":1622558650000},"page":"e0252516","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":22,"title":["Increased risk for developing gambling disorder under the treatment with pramipexole, ropinirole, and aripiprazole: A nationwide register study in Sweden"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5215-0276","authenticated-orcid":true,"given":"Mirjam","family":"Wolfschlag","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"H\u00e5kansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,6,1]]},"reference":[{"issue":"1","key":"pone.0252516.ref001","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1038\/s41572-019-0099-7","article-title":"Gambling disorder.","volume":"5","author":"MN Potenza","year":"2019","journal-title":"Nature reviews Disease primers"},{"issue":"4","key":"pone.0252516.ref002","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1556\/2006.5.2016.073","article-title":"Problem gambling worldwide: An update and systematic review of empirical research (2000\u20132015)","volume":"5","author":"F Calado","year":"2016","journal-title":"Journal of behavioral addictions"},{"issue":"4","key":"pone.0252516.ref003","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1097\/ADM.0000000000000690","article-title":"Gambling During the COVID-19 Crisis\u2014A Cause for Concern","volume":"14","author":"A H\u00e5kansson","year":"2020","journal-title":"Journal of addiction medicine"},{"issue":"3","key":"pone.0252516.ref004","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1007\/s10899-015-9582-6","article-title":"Problem Gambling Family Impacts: Development of the Problem Gambling Family Impact Scale.","volume":"32","author":"NA Dowling","year":"2016","journal-title":"Journal of gambling studies"},{"issue":"4","key":"pone.0252516.ref005","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1556\/2006.7.2018.112","article-title":"Gambling disorder, increased mortality, suicidality, and associated comorbidity: A longitudinal nationwide register study","volume":"7","author":"A Karlsson","year":"2018","journal-title":"Journal of behavioral addictions"},{"issue":"4","key":"pone.0252516.ref006","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1111\/ajad.12197","article-title":"Suicidal ideation and suicide attempts in five groups with different severities of gambling: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions.","volume":"24","author":"JF Moghaddam","year":"2015","journal-title":"The American journal on addictions"},{"key":"pone.0252516.ref007","doi-asserted-by":"crossref","first-page":"106872","DOI":"10.1016\/j.addbeh.2021.106872","article-title":"Gambling in patients with major depressive disorder is associated with an elevated risk of Suicide: Insights from 12-years of Nationwide inpatient sample data","volume":"118","author":"T Jolly","year":"2021","journal-title":"Addictive behaviors"},{"issue":"9","key":"pone.0252516.ref008","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1017\/S0033291708002900","article-title":"DSM-IV pathological gambling in the National Comorbidity Survey Replication","volume":"38","author":"RC Kessler","year":"2008","journal-title":"Psychological medicine"},{"key":"pone.0252516.ref009","author":"World Health Organization","year":"2020","journal-title":"ICD-11 for Mortality and Morbidity Statistics (Version: 09\/2020)"},{"key":"pone.0252516.ref010","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. 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