I am quoting Boann and starting a new thread on levodopa vs. agonists and
their role in obssessive-compulsive disorder or the newly named, dopa agonist blamed, ICD. Well, there is so much interesting stuff flying back and forth, I think it is getting lost in the original thread.

I think you ask the key question early on...

Why is levodopa always exonerated? It can't just be author bias; there are far too many studies isolating agonists so there must be a rigorous statistical measure being used (we can only hope).

I became curious as to how agonists fared in other treatments. It's used as a monotherapy in treating RLS and in 2007, The Mayo Clinic was the first to report correlation between compulsive behaviors and agonist treatment of RLS.

The newest study I could find further isolates:

Among the study patients with PD, new-onset compulsive gambling or hypersexuality was documented in 7 (18.4%) of 38 patients taking therapeutic doses of dopamine agonists but was not found among untreated patients, those taking subtherapeutic agonist doses, or those taking carbidopa/levodopa alone. Behaviors abated with discontinuation of agonist therapy or dose reduction.

from "Frequency of New-Onset Pathologic Compulsive Gambling or Hypersexuality After Drug Treatment of Idiopathic Parkinson Disease"
J. Michael Bostwick, MD, Kathleen A. Hecksel, MD, et al. MayoClinic Proceedings. April 2009.

I think the clincher is that stopping or reducing the agonist ended the behavior. I do wonder if the compulsive behavior problems are more prevalent in males (anecdotally, I hear more horror stories from them, but more men than women have PD) and what ages are prevalent when looking at many different studies? In the end, I think this goes along with the fact that some of us are more prone to addictive behaviors to begin with...drug addiction also center on dopamine transmission. If you think of how agonists work vs. straight levodopa, I'm not surprised that given the right environment an agonist can do more harm than good.

Laura

I agree Laura. I really don't know why we (on the other thread) are having the argument. We've all acknowledged that both carbo-levo-dopa and agonists elicit different side effects in different people. We each have our own stories about our own drug side effects. My experience doesn't negate another person's experience. What's true for one is not true for another.

That's a huge problem when it comes to treatment of PD. No one should be given a bottle of pills and told to come back in a year; yet that is often standard practice. Treating PD is an art that requires trial, error and patience.

Sinemet has its own set of problems that rarely are used as excuses to stop treatment. In fact, a whole area of research has grown around the question of how to treat Sinemet side effects.

It keeps coming back to the same conclusion for me - they, we, us - don't know exactly what we are dealing with. I hope I'm still around when they figure it out!

What other thread was there? I am at a loss for words, which is probably an improvement. So there has been, for a year, a warning that Levo-dopa causes the same destructive behavior as Mirapex does, but no one seems to have known about the warning, which comes 60 years after the drug was introduced? It required an Anuket to go and find out.
I don't know what is science and what is corporate game playing. Mirapex was under attack; what studies prompted Levo-dopa to quietly insert a new warning claiming that their product causes just as much damage as the one that has all the lawsuits for damages?
I used to think I understood the situation; now I can't make head nor tail of it.

Indigo,
you mention:
'a whole area of research has grown around the question of how to treat Sinemet side effects'

which reminded me of the last newsletter that came out of MJFF and the headline article was:

MJFF AWARDS $1 MILLION FOR CRITICAL STEP TOWARD NEW DYSKINESIA TREATMENTS.

I have to admit to doing a double take when I saw this, for exactly what you mention above, dyskinesia is not a symptom, it is a side-effect.

So the question that is going round my head is, just how much does this tell us about the state of play in the non-patient PD world......?

Combined with the new Merck/Schering Plow combo and their adoption of a matrix for diabetic tablet drugs and l-dopa that will extend delivery to nine hours........ there are no products as of yet, and we know what the timeline is from drug design to patient......

I have to admit being confused by what is going on in the wonderful world of levodopa, too.................

Laura, you raise some interesting issues on compulsive behaviours, I wonder if gambling and hypersexuality issues are less prevalent among women on agonists because of disposition, perhaps the compulsions that women are more prone to display are different, rather than occurring less - who for instance is documenting punding behaviours that people display in their homes, out of view, or perserverant behaviours that manifest in excessive anxiety which also come in on the compulsive spectrum, and have also been discussed over time on boards like this......and that can have equally devastating effects on day to day living.....

I agree, as yet none of us know what we are dealing with..... at the end of the day it is the patient who has to haul him/herself out of bed, and start another day living with PD...

Here's the link to the 4-page "discussion."
http://neurotalk.psychcentral.com/thread112146.html

Have fun!

Peg

Hi Laura

I wasn’t going to post anymore on this subject because it never seems to go well, but given your questions, I am going to post the briefest synopses I can of the most glaring problems of each gambling/ICD study I have ever read,

There will be at least six – I am going to post them as separate posts – they won’t be in chronological order.

The biggest lesson I have learned is that it is not enough to read just the abstract and the news coverage. One must read the actual study – and do it carefully – because abstracts and news coverage can be and are spun. The studies are, too, but it is harder to hide in the full study because more data must be provided.

the first three form the foundation upon which this idea that DAs cause these problems and they do so all by themselves rests.

one could speculate that broccoli has more potentially dangerous chemicals than sinemet.