Combined Sertraline and Naltrexone in Online Gambling Disorder with Comorbid Depression: A Three-Case Clinical Report

Introduction: Online Gambling Disorder is an increasingly prevalent behavioral addiction frequently accompanied by depressive symptoms and significant functional impairments. Despite growing clinical recognition, pharmacological treatment options remain limited, and empirical evidence regarding combination therapy strategies is scarce. Case Presentation: We report three male patients diagnosed with online gambling disorder and comorbid major depressive disorder according to DSM-5-TR criteria who demonstrated early clinical improvement following combined sertraline (50 mg/day) and naltrexone (titrated up to 100 mg/day) therapy integrated with structured motivational interviewing sessions provided through the Green Crescent Counseling Center (YEDAM), a community-based addiction support service in Turkey. From the second week of treatment, all patients reported a marked reduction in gambling urges and guilt distress, as reflected in both weekly clinical scale assessments and clinical interview findings. Clinical severity and symptom changes were assessed using the Online Gambling Addiction Scale (OGAS), Beck Depression Inventory (BDI), and Clinical Global Impression Scale (CGI-S) at baseline and weekly throughout the four-week period. By week four, consistent improvements were observed across all clinical measures. No clinically significant adverse effects were observed. Conclusions: This three-case clinical report suggests that combined sertraline and naltrexone therapy may represent a potentially useful and well-tolerated pharmacotherapeutic approach for managing online gambling disorder with comorbid depression. When integrated with community-based motivational interventions, this dual-pathway strategy may contribute to early clinical responses and treatment engagement. These findings should be interpreted as hypothesis-generating and warrant further investigation in controlled clinical trials.