Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Pramipexole exposure and risk of incident gambling disorder in individuals with psychiatric disorders : A nationwide register-based cohort study

Lindström, S LU orcid ; Wolfschlag, M LU ; Håkansson, A LU orcid and Berge, J LU (2026) In Journal of Affective Disorders
Abstract

BACKGROUND: Pramipexole, a dopamine agonist, has demonstrated antidepressant efficacy as an augmentation strategy in unipolar and bipolar depression. However, dopaminergic treatments are associated with impulse control disorders, including gambling disorder, and evidence regarding behavioural risks in psychiatric populations remains limited.

METHODS: We conducted a nationwide register-based cohort study including individuals with psychiatric disorders who were prescribed pramipexole between 2006 and 2021. Cumulative pramipexole exposure was quantified longitudinally and analysed as a time-varying variable. The primary outcome was incident, clinically diagnosed gambling disorder identified in specialised healthcare registers.... (More)

BACKGROUND: Pramipexole, a dopamine agonist, has demonstrated antidepressant efficacy as an augmentation strategy in unipolar and bipolar depression. However, dopaminergic treatments are associated with impulse control disorders, including gambling disorder, and evidence regarding behavioural risks in psychiatric populations remains limited.

METHODS: We conducted a nationwide register-based cohort study including individuals with psychiatric disorders who were prescribed pramipexole between 2006 and 2021. Cumulative pramipexole exposure was quantified longitudinally and analysed as a time-varying variable. The primary outcome was incident, clinically diagnosed gambling disorder identified in specialised healthcare registers. Associations were examined using Cox proportional hazards models, adjusting for relevant sociodemographic and clinical covariates.

RESULTS: During follow-up, incident gambling disorder was rare but occurred disproportionately among individuals with higher cumulative pramipexole exposure. A clear dose-response relationship was observed, with progressively increasing risk across exposure categories. Individuals with bipolar disorder exhibited a particularly elevated risk compared with other psychiatric diagnostic groups.

CONCLUSIONS: In this nationwide psychiatric cohort, cumulative exposure to pramipexole was associated with an increased risk of incident gambling disorder, with evidence of a dose-response relationship. Although the absolute risk of clinically diagnosed gambling disorder was low-likely reflecting substantial underdiagnosis-the clinical consequences of gambling disorder are considerable. These findings complement trial evidence by highlighting behavioural risks associated with long-term dopaminergic treatment in routine psychiatric care and underscore the importance of exposure-aware prescribing and systematic monitoring, particularly among individuals with bipolar disorder.

(Less)
Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Journal of Affective Disorders
article number
122033
publisher
Elsevier
external identifiers
  • pmid:42217644
ISSN
0165-0327
DOI
10.1016/j.jad.2026.122033
language
English
LU publication?
yes
additional info
Copyright © 2026. Published by Elsevier B.V.
id
ae46dcfe-db81-4c56-9960-04fa3e53183e
date added to LUP
2026-06-02 08:37:26
date last changed
2026-06-02 08:39:55
@article{ae46dcfe-db81-4c56-9960-04fa3e53183e,
  abstract     = {{<p>BACKGROUND: Pramipexole, a dopamine agonist, has demonstrated antidepressant efficacy as an augmentation strategy in unipolar and bipolar depression. However, dopaminergic treatments are associated with impulse control disorders, including gambling disorder, and evidence regarding behavioural risks in psychiatric populations remains limited.</p><p>METHODS: We conducted a nationwide register-based cohort study including individuals with psychiatric disorders who were prescribed pramipexole between 2006 and 2021. Cumulative pramipexole exposure was quantified longitudinally and analysed as a time-varying variable. The primary outcome was incident, clinically diagnosed gambling disorder identified in specialised healthcare registers. Associations were examined using Cox proportional hazards models, adjusting for relevant sociodemographic and clinical covariates.</p><p>RESULTS: During follow-up, incident gambling disorder was rare but occurred disproportionately among individuals with higher cumulative pramipexole exposure. A clear dose-response relationship was observed, with progressively increasing risk across exposure categories. Individuals with bipolar disorder exhibited a particularly elevated risk compared with other psychiatric diagnostic groups.</p><p>CONCLUSIONS: In this nationwide psychiatric cohort, cumulative exposure to pramipexole was associated with an increased risk of incident gambling disorder, with evidence of a dose-response relationship. Although the absolute risk of clinically diagnosed gambling disorder was low-likely reflecting substantial underdiagnosis-the clinical consequences of gambling disorder are considerable. These findings complement trial evidence by highlighting behavioural risks associated with long-term dopaminergic treatment in routine psychiatric care and underscore the importance of exposure-aware prescribing and systematic monitoring, particularly among individuals with bipolar disorder.</p>}},
  author       = {{Lindström, S and Wolfschlag, M and Håkansson, A and Berge, J}},
  issn         = {{0165-0327}},
  language     = {{eng}},
  month        = {{05}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Affective Disorders}},
  title        = {{Pramipexole exposure and risk of incident gambling disorder in individuals with psychiatric disorders : A nationwide register-based cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.jad.2026.122033}},
  doi          = {{10.1016/j.jad.2026.122033}},
  year         = {{2026}},
}