We know first-hand about the significant behavioral changes associated with
these drugs.  I doubt that it is as "rare" as they say.  I think it is
probably under-reported for numerous reasons including embarrassment, shame
and denial.

Carole and Ted (57/45/40, bilateral DBS 2/05)



----- Original Message -----
From: "M.Schild" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, July 26, 2005 12:08 AM
Subject: Agonists and gambling


> Some Parkinson's Drugs May Trigger Compulsive Gambling
>
> By Amanda Gardner
> HealthDay Reporter
>
> MONDAY, July 11 (HealthDay News) -- Eleven people with Parkinson's disease
> temporarily became compulsive gamblers after taking a class of drugs
designed
> to control movement problems caused by the illness, a new study reports.
>
>
>
> This is the latest in a series of case studies linking such drugs --
called
> dopamine agonists -- to pathological gambling in Parkinson's patients.
>
>
> "This lends continued support towards the hypothesis that family of
medicines
> may cause difficulty with behavioral issues in this population of
patients,"
> said Dr. M. Leann Dodd, lead author of the study and senior associate
> consultant in the department of psychiatry and psychology at the Mayo
Clinic,
> in Rochester, Minn.
>
>
>
> "It's a very rare side effect but we certainly want anyone treated to
> understand that the potential is there so that they are open to talk with
> their neurologists and get on top of these behaviors before they would
cause
> them any damage personally or professionally," she added.
>
>
>
> In addition, six of the patients in the new report developed other
behavioral
> problems in tandem with the pathological gambling. These included
compulsive
> eating, increased alcohol consumption, and an obsession with sex.
>
>
>
> The study, which appeared online Monday and will be published in the
September
> issue of Archives of Neurology, raises some tantalizing questions about
how
> addictions work and how they might be treated or cured.
>
>
> Parkinson's disease is characterized by the death of neurons in an area of
the
> brain known as the substantia nigra, and is usually treated with drugs
that
> enhance the dopamine-signaling system. While dopamine, a brain chemical,
> helps regulate movement and balance, it also plays a central role in the
> body's "reward" system and can reinforce various behaviors, not all of
them
> productive.
>
>
> The 11 case studies presented in the new study were startling, not just
for
> the dramatic onset of a dangerous compulsion, but because the reduction or
> discontinuation of the drug resulted in an equally dramatic cessation of
the
> habit.
>
>
> One 52-year-old married man started gambling "uncontrollably" after
raising
> the dose of his dopamine agonist. His wife phoned the neurologist to
report
> that her husband had lost more than $100,000, was eating compulsively --
he
> gained 50 pounds -- and had an obsession with sex that resulted in him
> carrying on an extramarital affair. The man lost his excessive interest in
> gambling and sex when the medication was tapered off, according to the
> report.
>
>
>
> Another man with no history of gambling started frequenting casinos for
days
> at a time, exhibited an increased sex drive, drank more alcohol and ate
> excessively. When his medications were stopped, he reverted to having sex
> once weekly instead of four times a day.
>
>
> And one 68-year-old man lost more than $200,000 gambling in six months and
> left town for days at a time without telling anyone where he was.
>
>
>
> All of the patients -- who were seen and evaluated between 2002 and 2004
at
> the Mayo movement disorders clinic -- started gambling only after starting
on
> a dopamine agonist: either pramipexole (nine of the 11 cases) or
ropinirole
> (two cases). The gambling stopped when the drug was reduced or
discontinued
> in eight of the 11 cases. The other three cases were not available for
> follow-up, the researchers said.
>
>
>
> "The fact that they were able to reduce the behavior by reducing or
getting
> rid of the drug implies that it was the drug," said Paul Sanberg,
> distinguished professor of neurosurgery and director of the University of
> South Florida Center for Aging and Brain Repair. "It pretty well verifies
> that dopamine stimulation underlies these negative behaviors."
>
>
> All the patients were given other therapy or a reduced dose of the same
> therapy for their Parkinson's symptoms.
>
>
> Since the paper was submitted for publication, the authors have identified
11
> more patients with similar problems. Previous studies have estimated that
> about 5 percent of people taking pramipexole may have the gambling side
> effect. Neurologists are beginning to take note and talk to patients about
> this potential side effect, Dodd said.
>
>
> The fact that compulsive gambling occurs more frequently with pramipexole
may
> provide clues into the nature of addictive behavior, the researchers said.
>
>
> Dopamine, a neurotransmitter, can sit on one of several different receptor
> sites in the brain. Pramipexole, it turns out, has a much higher affinity
for
> the receptor site D3 than others, Dodd said.
>
>
>
> "The D3 receptor seems to be localized and more concentrated in the limbic
> areas of the brain, those areas of the brain that are tied to emotions and
> internal reward systems," Dodd explained. "It would be very interesting to
> see whether or not medications that have the opposite effect on D3 might
curb
> some of these behaviors."
>
>
> Sanberg added: "Does this lead to potential treatments for blocking D3?
That's
> clearly something to look at."
>
>
>
> But the dopamine agonists still have value for Parkinson's patients, Dodd
> said.
>
>
> "This is not a medication to throw away. It's a good medication. It's
often
> used at lower doses for restless leg syndrome with very good response and
we
> still use it to treat many, many Parkinson's patients," she said. "[The
> gambling] is reversible. We want patients to be aware so that they can
bring
> it up. If someone were to notice just a slight change of behavior in their
> loved one, they could mention it to their neurologist."
>
>
>
> SOURCES: M. Leann Dodd, M.D., senior associate consultant, department of
> psychiatry and psychology, Mayo Clinic, Rochester, Minn.; Paul Sanberg,
> Ph.D., D.Sc., distinguished professor of neurosurgery, and director,
> University of South Florida Center for Aging and Brain Repair, Tampa;
> September 2005 Archives of Neurology
>
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