Lithium as an Adjunctive Stabilization Strategy for Impulsivity and Suicidality in Severe Gambling Disorder: A Case Report and Narrative Review

Gambling disorder (GD) is associated with severe psychosocial impairment, impulsive dyscontrol, affective instability, and increased suicidal risk. Pharmacological options remain limited, particularly for patients whose presentation is dominated by transdiagnostic dimensions such as impulsivity, emotional dysregulation, and suicidal vulnerability. Lithium may be relevant because of its anti-suicidal properties and potential effects on affective instability and behavioral dyscontrol. We describe a 40-year-old man with sports-betting-related GD who presented after a suicidal crisis in the context of financial collapse and marital conflict. He entered a structured multimodal program including psychiatric care, lithium carbonate, individual psychotherapy, psychoeducational and self-help groups, family intervention, and social support. During multimodal treatment, which included lithium carbonate titrated to 600 mg/day, the patient was observed to show progressive affective stabilization, remission of suicidal ideation, reduced gambling urges, and sustained abstinence, with one brief lapse that was rapidly contained. Psychometric reassessment showed selective improvement across gambling-related and functional domains, including reduced functional impairment and markedly reduced gambling-related cognitive distortions; however, global psychopathological distress remained substantially stable, and the GPQ subtype shift was interpreted only descriptively. Although causal inference is limited by the single-case design and multimodal treatment context, this case raises the hypothesis that lithium may have contributed, within a multimodal intervention, to the stabilization of core vulnerability dimensions in selected GD presentations, particularly impulsivity, affective dysregulation, and suicidality.