Originally Posted by boann (Post 62932)

Hi Carolyn,

i have been on Mirapex at the max recommended dosage for about 6 years, and i *have* engaged in compulsive behavior during that time - shopping, namely - but the first two studies that were published on gambling (such as they are - these studies are demonstrably baloney), the studies that started this whole furor, cite as their evidence of an association a temporal coincidence between starting/increasing the DA dosage and the onset of behavior and likewise with reduction/cessation of the drug and cessation of the behavior.

The onset of my behavior coincided not with any change to my Mirapex, but to my mother being diagnosed with cancer. I was already depressed at that time, and her struggle put me in a place i had never been before, where the thought of opening my mail or doing the dishes or showering were paralysing - and i found that shopping made me feel better, at least for a little while. the behavior resolved gradually, not with any change to my meds, but rather as i came out of the depression. (my mother is doing ok now)

the only study i have read that looked at DAs and behaviors other than gambling was as flimsy as they come.


my own experience, together with a close read of the three gambling studies, examination of the PIEN and CARE list archives looking for references to this phenomenon that preceded the publication of the first gambling study (there was one, maybe two, before 2003 - far from the epidemic one would have imagined based on the claims of some list participants) and discovering that the folks who did the "FDA" study that mined the Adverse [Drug] Event Recording system database failed to disclose that only *one* of the 39 reports linking Mirapex to gambling came in in the six years between it hitting the market and the publication of the first study in 2003 (there were three linking levodopa and gambling in the same time period - the authors left that out, too) - 38 came in after the publication of that study - all of these things bring me to conclude that this phenomenon has been created, not illuminated. if it had been illuminated, there would have been evidence of it preceding the publicity - there is none.

I haven't done as much reading about OCD as i have about gambling, but i can tell you this - my sense is that there are more studies linking behavior i would characterize as more OCD-like than gambling - they call it "punding" - and levodopa than dopamine agonists.

i would also pose the question that if too much dopamine running around the brain is seen to be responsible for such behavior, why on earth would levodopa, which turns into actual dopamine in the brain, not be as likely to cause these problems as DAs, which only mimic dopamine?

another question i would pose pertains the theory that it is the dopamine rush of the unexpected win that people with PD become addicted to in the case of gambling, because they suffer from a deficit of dopamine and therefore are more susceptible to the rush - but.... wouldn't taking something that replenishes the ambient level of dopamine in the brain *reduce or eliminate* rather than exacerbate that problem?

Finally, I would point out that all of these behaviors are noted as starting with the start or increase of a DA - maybe it is just me, but it seems to me self evident that a worsening of symptoms that requires a the initiation of or an increase in meds is *depressing!* and depression has long been correlated with gambling, and - this is, of course, an extremely unrefined piece of information - over 600 hits if you search on the terms OCD and depression together in PubMed.

I remain unconvinced that DAs are any more likely than levodopa or buproprion (wellbutrin, a dopamine re-uptake inhibitor) to cause such behaviors, and i have yet to see compelling evidence (excludes anecdote) that *any* of them cause such behavior.

my own advice would be to give close examination to the circumstances in one's life that could *also* be responsible for such behavior, and to give serious consideration to the side effects of what one would probably take instead, i.e., levodopa, keeping in mind how long people generally live with this disease (15-20 years) and the length of the typical levodopa "honeymoon period," i.e., 5 years - in addition to whatever your own personal priorities and symptom constellations are, and anything else that is relevant for you - and then make a decision.

or you could always just stop for a bit and see what happens - you can always go back on.

i probably have several studies on compulsive behavior of various kinds and dopaminergic therapy, if you are interested.

my 250,476 cents,
boann

Originally Posted by BEMM (Post 63883)

I am so sorry, no wonder you feel depressed, having one serious illness is already one too many.
About agonists, the Doctors you mentioned, at University of Pennsylvania, are conducting the survey in which I participated this past December. The survey is sponsored by the drug companies that produce Mirapex and Requip. They are pairing up patients who experience obsessive behaviour for a long term study. Obviously they are still taking the problem very seriously.
I wish you strength and courage and thorough mending from the illness that is mendable. I hope all the very best for you.

birte