The main approach in treating pathological gambling is and probably will remain psychotherapy. Based on certain neurobiological and neurochemical changes, psychopharmacological modulation of basic gambling symptoms could also be considered. The craving and urge to gamble could be mainly affected. Although there were great hopes expressed for treatment with selective serotonin reuptake inhibitors or mood stabilisers, studies conducted with them ended inconsistently. The hope for the future is pharmacologically focusing on the glutamate and opioid systems. In the first case, treatment would be aimed toward renewing glutamate homeostasis, which could be achieved with N-acetylcysteine or memantine. In the latter case, there are promising effective opioid receptor antagonists, such as naltrexone and nalmefene. However, pharmacological studies of pathological gambling are still insufficient to formulate more general conclusions and follow-ups of a much larger number of patients are needed, lasting at least one year. Pathological gambling is in fact not only serious, but also a chronic, often lifelong disorder. Nevertheless, current available data allow the compilation of certain recommendations for psychopharmacological treatment of pathological gambling.

Key words: pathological gambling – psychopharmacological treatment of pathological gambling – N-acetylcysteine – memantine – naltrexone – nalmefene