Addiction. 2010 Oct 6.

Impulse control disorders in patients with Parkinson's disease receiving dopamine replacement therapy: evidence and implications for the addictions field.
Ambermoon P, Carter A, Hall WD, Dissanayaka NN, O'Sullivan JD.

The University of Queensland, UQ Centre for Clinical Research, Australia The University of Melbourne...
Abstract
Aims  To describe the prevalence, phenomenology and correlates of 'impulse control disorders' (ICDs) in patients with Parkinson's disease (PD) treated with dopamine replacement therapy (DRT); to assess the strength of the evidence that DRT plays a contributory causal role in these disorders; and to highlight the implications of these disorders for research in the addiction field.

Methods:  PubMed and Web of Science databases were searched and the reference lists of papers examined.

Results:  The prevalence of ICDs in Parkinson's patients using DRT varied between 3.5% and 13.6%, depending on the severity and range of disorders assessed. PD patients with ICDs were: generally younger; had an earlier onset of PD; had a personal or family history of substance abuse or an ICD; and were more likely to be treated with dopamine receptor agonists (DA agonists) than levodopa (l-dopa). There is reasonable evidence that dopaminergic medications play a causal role in ICDs in that they occur at a higher rate in an otherwise low-risk population of adults, begin after initiation of DA agonist therapy and cease upon its discontinuation. A causal relationship is biologically plausible, but the role of other factors (such as concurrent mood disorders) remain to be clarified by better-controlled studies. Conclusions  Impulse control disorders among patients with Parkinson's disease receiving dopamine replacement therapy may provide a unique opportunity for addiction researchers to study the neurobiology of impulsive forms of behaviour (such as problem gambling) that appear to be caused, in part, by the therapeutic use of dopamine receptor agonists.

© 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.
PMID: 21134016 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/2...?dopt=Abstract

This probably happens frequently with various topics but the sloppiness with which this was written is so annoying. I can tell the author is referring only to dopamine agonists being associated with ICD's. Unfortunately one has to read so carefully to not make the assumption or conclusion from what he is saying that what he refers to as DRT does not include levodopa or other forms of direct supplementation with dopamine.
Equating dopamine agonists with DRT is not at all accurate in my book.
This is particularly frustrating because having a generalized association between PWP and impulse control problems is not the most flattering one to have. Oh bother!

Well, hate to tell you this, but it already is associated as per labelling of many non-agonist products, such as Sinemet.

Read: http://neurotalk.psychcentral.com/thread112455.html

There were several ICD studies in 2010.

I believe the numbers are 7% on non-agonists, 17% agonists. The REAL figures are no doubt much higher

Impulse control disorders and link to treatment in Parkinson disease: cross-sectional study Reference: Arch Neurol 2010; 67: 589-595.

Source: Arch Neurol

Date published: 11/05/2010 16:40
Summary
by: Yuet Wan Impulse control disorders (ICDs), such as problem or pathological gambling, compulsive buying, compulsive sexual behaviour, and binge or compulsive eating, have been reported in Parkinson disease (PD). A link has also been reported between ICDs in PD and use of dopamine agonist treatment, levodopa treatment and post deep-brain stimulation surgery.



The DOMINION Study assessed the point frequency of four ICDs in PD and their association with dopamine-replacement therapies and other clinical measures. It involved 3090 patients with treated idiopathic PD from 46 centres in the US and Canada. The main outcome measures were:



• The Massachusetts Gambling Screen score for current problem/pathological gambling

• The Minnesota Impulsive Disorders Interview score for compulsive sexual behaviour and buying

• Diagnostic and Statistical Manual of Mental Disorders research criteria for binge-eating disorder



The following findings were reported:



• An ICD was identified in 13.6% of patients (gambling 5.0%, compulsive sexual behaviour 3.5%, compulsive buying 5.7%, and binge-eating disorder4.3%), and 3.9% had 2 or more ICDs.



• ICDs were more common in patients treated with a dopamine agonist than not (17.1% vs. 6.9%; odds ratio, 2.72; 95% CI, 2.08 to 3.54; p <0 .001).



• ICD frequency was similar for pramipexole and ropinirole (17.7% vs. 15.5%; 1.22; 0.94 to 1.57; p = 0.14).



• Other variables independently associated with ICDs were levodopa use, living in the US, younger age, being unmarried, current cigarette smoking, and family history of gambling problems.



The researchers conclude from these findings that “dopamine agonist treatment in PD is associated with 2- to 3.5-fold increased odds of having an ICD. This association represents a drug class relationship across ICDs. The association of other demographic and clinical variables with ICDs suggests a complex relationship that requires additional investigation to optimise prevention and treatment strategies.”

http://www.utexas.edu/research/asrec/dopamine.html

Cocaine, ecstasy, amphetamines, dope, nicotine - they all intertwine

Off for a cigarette

Yes! I am sooooo weary of this association. For starters, it does cause problems in some people to varying degrees, but what these "research" studies fail to mention is that the environment has to be wired to make this happen in the first place AND that the drug alters the plasticity of the brain itself, so people on agonists end up with too much dopamine in a key area of the brain. This all factors into the mix, but most studies do not bother to mention these nuances. Further, it pretty much is the agonist, people generally "normalize" off the meds.

Also, take into consideration that there are now increasing studies on patients with Restless Leg Syndrome treated with agonists who are experiencing the same thing, so it is not levodopa; though that would for sure exacerbate the whole thing.

Further, what they don't reveal is that the drug itself can be addictive. Last year, a doctor, actually published that clinically people were experiencing withdrawal symptoms (we knew this for some time already) and have now identified a distinct experience known as DAWS Dopamine Agonist Withdrawal Syndrome.

I can link to references but a quick search of the archives here should yield most of it for you.

Laura

Though a cynic 6 months ago before I trod this path, now I'm paranoid to boot

What exactly do you mean by impulse control disorder? I think I may have this.

krugen,

andy grove, founder of Intel and pwp, wrote a book called "Only the Paranoid Survive."

Karen,

Welcome to the forum. Impulse control disorders cover a spectrum of behaviors, beginning with punding at the low end to pathological behaviors like gambling, hypersexuality, etc. The problem is that you don't recognize what is happening until things are out of control. People have destroyed relationships, lost homes, etc over this. When you stop taking the agonist, the behavior stops.

I actually thought I was untouched by this until I woke up one morning (after stopping Mirapex) and realized that I had amassed quite a bit of knitting yarn, only I had never actually knit anything! The good news for me is that I was able to start Requip XL and the shopping compulsion stopped.

If you have noticed any unusual shopping pattern changes or find yourself rationalizing doing something repeatedly, talk to your doctor.

Hope this helps!

Laura