Dopaminergic Therapy for Parkinson's Disease Raises Risk for Impulse Control Disorders

News Author: Kathleen Louden
CME Author: Laurie Barclay, MD
Disclosures
Release Date: June 26, 2008
http://www.medscape.com/viewarticle/576691?src=rss

June 26, 2008 (Chicago, Illinois) — A new study performed in 3090 patients with Parkinson's disease found a 2- to 3-fold increased risk of having an impulse control disorder among patients treated with dopamine agonists compared with those who did not receive dopaminergic therapy.

The multicenter cross-sectional study examined in Parkinson's disease patients the prevalence of 4 impulse control disorders: problem or pathologic gambling, compulsive buying, compulsive sexual behavior, and binge eating.

The results were presented here at the 12th International Congress of Parkinson’s Disease and Movement Disorders.

"It is the largest study showing an association [between impulse control disorders and Parkinson's disease medications] and the only one to study all 4 of these disorders," lead author Daniel Weintraub, MD, told Medscape Neurology & Neurosurgery.

Dr. Weintraub, assistant professor of psychiatry at the University of Pennsylvania, said that impulse control disorders appear to be common in patients with Parkinson's disease receiving dopamine agonists. Their study showed that 13.6% of all treated patients had at least 1 such disorder (17.1% in patients receiving dopamine agonists). Of the patients with an impulse control disorder, 36% had more than 1 of these disorders.

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Carolyn,
Mirapex and Requp almost took my marriage, job, reputation, and sanity. I believe those numbers are low due to people not wanting to report such behaviors and doctors not asking embarrassing questions. I'm concerned about those who are suffering from side effects and don't realize it. This "drug affected" behavior is a strange fog you live in and the guilt (over the things you do and say) is overwhelming.
Slowmo

oK - what else?

paula

Editing to address Carolyn - didn't see slowmo and don't mean to minimize this. We all know that -what's next? Hope you understand what i meant.

Yes, Paula, I knew what you meant. I thought the same thing when I initially read this news item...but I thought it was news worthy anyway.

I am a compulsive shopper...just check out my bank account...LOL.
Can go into a needlework shop for a package of needles and just come out with that, I have to buy whatever I can't resist.

Sounds like small potatoes, but it is not.

One specialty piece of linen can cost from $50 to over $100, and thread/fibers can be up to $7 a spool...and one project could need 20 or more of those fibers. You do the math.

I am still working on one project that cost me $235 in total. I am determined to finish it because of the cost.

I was considering starting Mirapex for my tremors, particularly since the Neupro patch got taken off the market. But since I've been reading about the medication, I can't find anyone who's gotten any benefit from it. It's scary. Now I don't really know what to do. My Azilect is working great, and I hope to sustain on that for a while.

but I also think dopamine contributes to these behaviors, also. I'd like to see some studies comparing that (agonists against dopamine therapy). This wouldn't be very difficult to do now that dopamine agonists are used as monotherapy.

I don't know if they did any dopamine-or non-dopamine agonist treated comparisons in this study or not. I couldn't get access to the article.

Thanks, Carolyn. Most of these studies came from Duke - this one is from a new author and seems pretty large (over 3,000).

Peg

All these involve the "Reward" circuitry, of course. Could it simply be our thirst for dopamine leads us to seek the rush of the slot machine, the bleached blonde, or the cash register? Are there any constructive ways to tap into it?