Bupropion Shows Different Effects on Brain Functional Connectivity in Patients With Internet-Based Gambling Disorder and Internet Gaming Disorder

Abstract

Introduction: Internet gaming disorder (IGD) and gambling disorder (GD) share similar clinical characteristics but show different brain functional connectivity patterns. Bupropion is known to be effective for the treatment of patients with IGD and GD. We hypothesized that bupropion may be effective for the treatment of Internet-based gambling disorder (ibGD) and IGD and that the connections between the default mode network (DMN) and cognitive control network (CCN) would be different between ibGD and IGD patients after 12 weeks of bupropion treatment.

Methods: 16 patients with IGD, 15 patients with ibGD, and 15 healthy subjects were recruited in this study. At baseline and after 12 weeks of bupropion treatment, the clinical symptoms of patients with IGD or ibGD were assessed, and brain activity was evaluated using resting state functional magnetic resonance imaging.

Results: After the 12-week bupropion treatment, clinical symptoms, including the severity of IGD or GD, depressive symptoms, attention, and impulsivity improved in both groups. In the IGD group, the functional connectivity (FC) within the posterior DMN as well as the FC between the DMN and the CCN decreased following treatment. Moreover, the FC within the DMN in the IGD group was positively correlated with changes in Young Internet Addiction Scale scores after the bupropion treatment period. In the ibGD group, the FC within the posterior DMN decreased while the FC within the CCN increased after the bupropion treatment period. Moreover, the FC within the CCN in the ibGD group was significantly greater than that in the IGD group.

Conclusion: Bupropion was effective in improving clinical symptoms in patients with IGD and ibGD. However, there were differences in the pharmacodynamics between the two groups. After 12 weeks of bupropion treatment, the FC within the DMN as well as between the DMN and CCN decreased in patients with IGD, whereas the FC within the CCN increased in patients with ibGD.

Keywords: Internet gaming disorder; bupropion; cognitive control network; default mode network; gambling disorder.

Figure 1

Study procedure. Abbreviations: IGD, Internet gaming disorder; ibGD, Internet-based gambling disorder; D/O, dropped out; fMRI, functional magnetic resonance imaging.

Figure 2

Changes in brain functional connectivity after 12 weeks of bupropion treatment. Red line: increased functional connectivity (FC), blue line: decreased FC, In the IGD group at baseline, the functional correlation between the middle frontal gyrus (MPFC) and left inferior prefrontal cortex (IFGLt) (t = 3.39, FDRq = 0.0026), left dorsolateral prefrontal cortex (DLPFCLt) and right lateral parietal cortex (LPRt) (t = 3.34, FDRq = 0.0030), and left posterior parietal cortex (PPCLt) and IFGRt (t = 3.67, FDRq = 0.0013). At 12 weeks, the functional correlation between the posterior cingulate cortex (PCC) and LPRt (t = −3.26, FDRq = 0.0017), LPRt and PPCRt (t = −3.16, FDRq = 0.0023), and LPRt and PPCLt (t = −3.42, FDRq = 0.0012). In ibGD group at baseline, the functional correlation between the PCC and LPLt (t = −3.36, FDRq = 0.0014), PCC and LPRt (t = −3.26, FDRq = 0.0027). At 12 weeks, the functional correlation between the PCC and PPCLt (t = −3.23, FDRq = 0.0031), PCC and PPCRt (t = −3.25, FDRq = 0.0031). The functional correlation between the PPCLt and PPCRt (t = 3.12, FDRq = 0.0042). In the IGD vs ibGD comparison (repeated measure analysis of variance), the ibGD group showed increased FC between IFGRt and PPCLt (F = 3.67, p = 0.0013), compared with IGD group.

Figure 3

Correlation between the changes in clinical scales and the changes in brain functional connectivity. (A) In the Internet gaming disorder (IGD) group, the functional connectivity between the posterior cingulate cortex (PCC) and right lateral parietal cortex (LPRt) was positively correlated with the changes in the Young Internet Addiction Scale scores from baseline to 12 weeks (r = 0.69, p < 0.01). (B) In the ibGD group, the changes in FC between the left posterior parietal cortex (PPCLt) and right posterior parietal cortex (PPCRt) were negatively correlated with the changes in the Yale-Brown Obsessive Compulsive Scale for pathologic gambling (YBOCS-PG) scores from baseline to 12 weeks (r = −0.68, p < 0.01).