Thread by @psycheureka

What treatment strategies align best with the neurobiology of Internet Gaming Disorder (IGD)?

A 2016 six-week RCT in treatment-seeking young adult males suggests bupropion may be more effective than escitalopram for IGD, particularly for impulsivity and attention deficits, though findings are limited to a controlled cohort.

Let’s examine the neurobiological implications and clinical relevance for managing reward dysregulation and executive dysfunction.

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The trial asked a targeted clinical question:

Can pharmacotherapy improve core IGD symptoms, especially in those with attentional and impulse control challenges?

119 young males with IGD were randomised to:

● Bupropion SR (150–300 mg/day, n=44)

● Escitalopram (10–20 mg/day, n=42)

● Observation (n=33)

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Multiple symptom domains were tracked:

● YIAS: Internet gaming severity

● ARS: Attention deficits

● BIS/BAS: Impulsivity

● BDI: Depressive symptoms

● CGI-S: Global clinical severity

Measured at baseline, week 3, and week 6.

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Bupropion led to greater improvement in global function and addiction severity.

Participants receiving bupropion had significantly greater reductions in CGI-S and YIAS scores compared to both escitalopram and observation.

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Only bupropion improved attentional control and impulsivity.

ARS scores: ↓ inattention

BIS scores: ↓ impulsivity

Escitalopram showed no effect on these dimensions.

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Mood symptoms were not different between groups.

No statistically significant difference in BDI score reduction was observed between groups (p = 0.81).

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What explained the overall clinical improvement? Not depression.

Regression analysis showed that reductions in CGI-S scores were significantly associated with improvements in:

● Internet gaming severity (YIAS)

● Attention deficits (ARS)

● Impulsivity (BIS)

Changes in depressive symptoms (BDI) did not significantly predict global clinical response.

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Mechanistically, bupropion may better match IGD pathophysiology.

Its dual action on dopamine and norepinephrine targets the disrupted reward and executive control circuits implicated in IGD.

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Escitalopram fell short, especially for cognitive control.

The SSRI’s serotonergic profile showed no benefit for attention or impulsivity in this cohort.

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Important limitations to consider:

● Male-only sample

● Short study duration (6 weeks)

● No placebo group

● Cultural setting (South Korea) may limit broader applicability

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Clinical interpretation:

In young adult males with IGD and executive dysfunction, bupropion may offer greater benefit than escitalopram, particularly for attentional and behavioural regulation.

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Future research directions:

● Inclusion of female participants

● Longer-term outcome tracking

● Combination therapy with CBT

● Cognitive and functional outcomes

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