Pharmacotherapy for online behavioral addictions: a systematic review

INTRODUCTION: In response to the increasing prevalence of online behavioral addictions, researchers have investigated various treatment approaches, including pharmacotherapies. This systematic review aimed to summarize pharmacotherapeutic studies of online behavioral addictions. METHODS: PubMed, MEDLINE, and Embase were searched to identify randomized controlled trials or quasi-experimental studies of pharmacotherapy for online behavioral addictions. Studies were excluded if they only targeted offline behavioral addictions. Study findings were summarized, and the Effective Public Health Practice Project Quality Assessment Tool was used for quality assessment. RESULTS: This systematic review included 20 studies (1016 participants). Bupropion, selective serotonin reuptake inhibitors (SSRIs), and opioid receptor antagonists were most frequently studied and showed preliminary promise in reducing symptom severity. Many pharmacotherapeutic studies addressed co-occurring concerns, such as depression. CONCLUSIONS: Pharmacotherapies for online behavioral addictions appear promising, but the evidence base was limited by small samples, few randomized controlled trials, and short follow-up periods. Given preliminary support for psychotherapy + pharmacotherapy for problematic gaming, future research may evaluate the efficacy of combined treatment for a broader range of online behavioral addictions. Future research should also investigate pharmacotherapies for emerging problematic online behaviors, such as AI-based sexual engagement and problematic cryptocurrency trading.