Abilify, one of the most frequently prescribed psychiatric drugs, may contribute to destructive impulse control disorders such as compulsive gambling.

Also known by its generic name aripiprazole, Abilify is approved by the FDA as a treatment for schizophrenia and for manic or mixed episodes associated with bipolar disorder.

It’s also approved for use in combination with an antidepressant to treat depression. In younger patients, Abilify is approved to treat behavioral symptoms associated with autistic disorder and Tourette’s syndrome.

Thanks in part to its many different applications, Abilify’s popularity is beyond dispute. In 2013, sales of Abilify in the U.S. alone exceeded $6.4 billion, making it the top-selling drug in the U.S.

Abilify is one of a class of drugs known as dopamine receptor agonists. These drugs as a group have been associated with compulsive gambling and other impulse control disorders.

The Link Between Abilify and Compulsive Behavior

Study after study has shown a connection between Abilify and harmful compulsive behavior. One study published online in JAMA Internal Medicine in October 2014 studied 2.7 million reports from the FDA’s Adverse Event Reporting System from 2003 to 2012. The researchers found a significant association between dopamine receptor agonist drugs like Abilify and serious impulse control disorders.

The research revealed 1,580 reports of impulse control disorders in patients in the United States and 21 other countries. Of these, the most frequent disorder reported was compulsive gambling, followed by hypersexuality, compulsive shopping, and poriomania, or the urge to wander away from home. Almost 45 percent of these reported events were associated with Abilify or other dopamine receptor agonist drugs.

Doctors invited to comment on the study felt that patients should be warned about the risks. They also encouraged doctors to inquire about the behavioral side effects of medication, not just physiological ones like dizziness, rash or nausea. They concluded that Abilify and similar drugs should be used “less frequently and with great caution, paying close attention to possible untoward effects on behavior and impulse control.”

Earlier studies also suggested a link between Abilify and developing a gambling problem. In a French study published in 2013, seven Abilify patients with a gambling problem regained control of their behavior after they discontinued Abilify. Another study from 2011 found schizophrenic patients with no history of gambling addiction developed an uncontrollable gambling problem after taking Abilify.

What Causes Compulsive Gambling?

Researchers aren’t sure what it is about Abilify that could lead to compulsive behavior. They believe the drug operates on the way the brain uses dopamine and serotonin, neurotransmitters that regulate mood and behavior. Dopamine in particular is associated with a subjective sense of pleasure than can encourage certain behaviors, such as eating. It’s possible that Abilify may over-activate the dopamine system, triggering compulsive behavior like excessive gambling.

Despite the evidence linking Abilify to compulsive gambling, the FDA-approved label for Abilify does not have a boxed warning alerting doctors and patients to that risk.

Attorneys are now investigating whether patients who suffer from a gambling problem after taking Abilify may have a legal claim. It’s possible that manufacturers Bristol-Myers and Otsuka America did not adequately warn doctors and patients about the gambling problem risk associated with Abilify.