Given the rates of pathological gambling and its impact on affected individuals and their relatives, effective treatments are needed. There are, however, no approved pharmacological treatments for pathological gambling. This paper describes the development of pharmacological treatments for pathological gambling and is based on a review of the literature published in the past 10 years. Important studies were carried-out on antidepressants, mood stabilizers, and antipsychotic agents. In the absence of comorbid psychiatric disorder, these studies did not conclude to the efficacy of these psychotropic drugs. A possible efficacy of opiate antagonist treatment for pathological gambling has been replicated in a number of placebo-controlled studies. Preliminary results on N-acetyl cysteine, Memantine and Topiramate produced significant improvement for pathological gamblers and may open new avenues for treatment.