Key Points

• Patient case reports evaluated after the FDA approved Abilify in 2002 suggest that Abilify gambling addiction has occurred in some people. This may result in intense urges to gamble and the inability to control these urges.
• In most people, but not all, this effect appears to be reversible upon dose reduction or discontinuation of the medicine.
• The mechanism of gambling addiction, or other impulse-control disorders, with Abilify is not fully known. It is thought to be due to dopamine agonist activity at the receptor sites in the brain. Dopamine is a neurotransmitter associated with pleasure, reward and movement.

The frequency of compulsive gambling with Abilify has not been reported by the manufacturer. Research suggests most cases occur from a few days to one year since the start of treatment and usually resolved after stopping drug treatment.

Healthcare providers should consider lowering the dose or discontinuing the medication if a patient develops such urges, although this may not be effective for everyone.

In case reports sent to the FDA Adverse Events Reporting System from 2003 to 2012, 1580 impulse control disorders were identified. Dopamine agonists, like pramipexole and the atypical antipsychotic aripiprazole (which has dopaminergic properties), showed the strongest association.

However, it is important to consider that some impulse-control disorders like pathological gambling may also be associated with underlying health conditions, such as Parkinson's disease or schizophrenia. These disorders are complex and individual and environmental factors may also play a role in development.

Why is Abilify prescribed?

In the U.S., Abilify (aripiprazole) is an atypical antipsychotic medicine used to treat schizophrenia, bipolar I disorder, Tourette's Disorder, irritability associated with autistic disorder, and as add-on treatment for major depressive disorder. The injectable form is also indicated for the treatment of agitation associated with schizophrenia or bipolar mania.

What are the symptoms of compulsive gambling?

Common signs or symptoms of a pathological gambling disorder, based on DSM-5 Diagnostic Criteria, may include:

• Lying to friends, family and others to hide the extent of your gambling.
• Needing to borrow money from others to remedy financial problems due to excessive gambling.
• Obsessed with gambling activities; constantly planning gambling activities and how to get more gambling money.
• Gambling with increasing amounts of money; trying to get back lost money by gambling more (chasing losses); continuing to gamble despite financial loss.
• Trying to control your gambling activities or stop gambling without success.
• Feeling restless, anxious or irritable when you try to cut back on gambling.
• Gambling to escape problems or relieve feelings of helplessness, guilt, anxiety or depression.
• Negative effects on relationships, work, or school because of gambling.

How do I handle Abilify and compulsive gambling?

Contact your healthcare provider right away if you sense uncontrollable urges to gamble. Abilify and gambling behaviors may result in harm to you and others if not recognized. You may need a dose adjustment or a new medication.

Healthcare providers should ask patients about any impulses or compulsions because patients may not recognize them as new or unusual. Denial is typically a feature of compulsive or addictive behaviors.

Healthcare providers should also closely monitor for new or worsening uncontrollable urges in patients at higher risk for impulse-control problems. These include those with a personal or family history of obsessive-compulsive disorder, bipolar disorder, impulse-control disorder, bipolar disorder, Parkinson's disease, impulsive personality, alcoholism, drug abuse, or other addictive behaviors.

Healthcare professionals should consider lowering the dose or discontinuing the medication if a patient develops such urges. Patients should not adjust doses or stop treatment without speaking to their healthcare provider first.

Does Abilify cause addictions beside gambling?

Compulsive urges besides gambling have been reported with Abilify, although less frequently. These include:

• sexual urges
• compulsive shopping
• binge eating or compulsive eating (eating you cannot control)

What medication can cause gambling addiction?

Studies suggest a strong correlation between medicines with dopaminergic and dopamine agonist properties and pathological gambling. Dopamine 3 (D3) receptor agonists are most frequently correlated with gambling and similar behavioral conditions. However, aripiprazole (Abilify), an atypical antipsychotic, is a partial agonist at D2 receptors, and also has agonist and antagonist activity at some serotonin receptors (5-HT1a and 5-HT2).

In one small case study from Italy in 94 people, spontaneous reports of pathological gambling were associated with several medications. Reports were gathered from 2002-2018. Percents of gambling reported in people taking various suspected medicines were as follows:

• pramipexole (56%)
• ropinirole (15%)
• levodopa combinations (12%) - levodopa is converted to dopamine in the brain
• rotigotine (5%)
• aripiprazole (5%)
• cabergoline (4%)
• pergolide (2%)
• apomorphine (1%)

In at least one case, patients were on multiple treatments with dopaminergic activity. In addition, Parkinson’s disease, which many of these drugs are approved to treat, has been linked to compulsive gambling, shopping or eating. No cases were listed as serious.

This study may have been limited by factors such as sample size, under-reporting, quality of data and lack of information.

Examples of other drugs with gambling side effects or warnings in the product label include: amantadine, brexpiprazole, bromocriptine, entacapone and selegiline.

Have there been Abilify gambling lawsuits?

Yes, lawsuits have been filed in the U.S. by plaintiffs alleging harm or financial loss from impulse-control disorders due to Abilify.

Abilify has been listed in published case reports and product labeling as a possible cause of impulse-control disorders such as compulsive gambling, binge or compulsive eating, sexual urges and compulsive shopping. However, it should be noted that impulse-control symptoms can be associated with underlying medical conditions such as Parkinson’s disease, as well as several mental health disorders.

Abilify Lawsuits

Compulsive behaviors linked with Abilify have been reported in the media, according to Drugwatch, a drug and medical device safety information site for consumers. More than 2,600 Abilify lawsuits had been filed in federal court against Bristol-Myers Squibb Company and Otsuka Pharmaceutical Co., the manufacturers, as of June 2019.

• Some lawsuits claimed that the drug companies did not warn doctors, patients or consumers that Abilify could cause compulsive behaviors like gambling, binge eating, or compulsive shopping.
• Also included in some lawsuits were harms due to suicide thoughts / attempts and playing video games.
• Although terms of the settlements were not revealed, the manufacturers settled thousands of cases with claims of harm or lost expenses due to compulsive behaviors.
• Abilify class-action lawsuits were also filed in Canada.

In May 2016 the FDA posted a new Abilify drug safety communication. They noted product information would be updated to include warnings for impulse-control behaviors, including the professional information and the patient Medication Guides for all aripiprazole (Abilify) products.

Learn More: Aripiprazole (Abilify, Abilify Maintena, Aristada): Drug Safety Communication - FDA Warns About New Impulse-control Problems

This is not all the information you need to know about Abilify (aripiprazole) for safe and effective use and does not take the place of your doctor’s directions. Review the full Abilify information and discuss this information and any questions you have with your doctor or other health care provider.