The complex relationship between gaming and mental health has gained significant attention, revealing a complex interplay of positive and negative impacts. This comprehensive review explores three fundamental mechanisms shaping this relationship: coping and escapism, psychological needs fulfillment, and obsessive engagement. These mechanisms interact with key moderators such as stress, social interaction anxiety, loneliness, psychological resilience, and gender, amplifying or mitigating gaming\'s effects on mental well-being. Our mechanistic evaluation proposes a collaborative and evidence-based framework that can be an essential therapeutic modality. Future research should target the development of an integrative framework based on mechanisms elucidated in this review that will allow practitioners to connect research with practice guide interventions by fostering partnerships with stakeholders, which include the gaming industry, educators, parents, and caregivers. The approach ensures responsible gaming practices and well-being tools are integrated, offering a balanced compass to navigate the complex dynamics of gaming and mental health in an ever-evolving landscape.