hi maryse -

again, trying to reign myself in here (never mind, i
am realizing it is impossible!) - i hope my attempt at
writing something short of an epic doesn't come off as
terse - it is not meant that way.

-- agreed that knowing the possible side effects is a
good thing, and as i said, i don't mean to minimize
the devastation that some people have experienced
-- i understand that we all have to choose meds - 40
years down the line, if levodopa is still considered
the best, we need better meds from which to choose
-- very glad that l-dopa was a big improvement - 40
years ago. that it is still considered the gold
standard (a designation that, after finding out that
dopamine agonists claimed 50% of PD market share in
2002, to l-dopa's 30%, i find even more questionable)
is both shameful and difficult to comprehend

but back to the issue of gambling, the question is, is
mirapex really responsible for it? after reading the
Dodd study (the one that concludes mirapex is
associated with gambling), taking a peek at their
"survey" of the literature, reading the study they
decide not to include in their survey, searching on
pubmed for all permutations of L-dopa and levodopa and
gambling and hypomania (obsessive/compulsive behavior)
i have discovered that:

-- 99% of the subjects both the Dodd study and all the
studies cited in Dodd's survey of the literature were
also on l-dopa

-- l-dopa has been associated with hypomania since
before dopamine agonists existed

-- searching for levodopa and gambling on pubmed turns
up even more hits (12) than the Dodd's survey of
literature did using Parkinsons disease and gambling
(9)

-- the Dodd survey of the literature eliminated from
consideration the study with the largest population of
gamblers to date - 12 out of 250 (and the largest
percentage, 4.5%, well above both the general
incidence and the Dodd study incidence of 1.5%)
because the meds were simply listed as "levodopa
therapy" - as if it were not possible that these
people were just on levodopa and nothing else?

 -- out of the 9 who were on mirapex, two didn't show
symptoms of gambling addiction until one year after
either starting or upping their dosage, one didn't
show symptoms for two years, and a fourth didn't start
gambling for two and a half years - now tell me - how
can those behaviors be blamed on mirapex? just because
the behavior stopped when the mirapex was stopped? did
they know when they stopped taking the mirapex that it
was supposed to eliminate the gambling problem?
couldn't that be a sort of reverse placebo effect? and
if no one stopped l-dopa instead of mirapex, how could
they know that it was mirapex alone that was
responsible?

so i think the question has to be asked, how can one
conclude, from this information, that dopamine
agonists ALONE are responsible for this [teensy
weensy] increased incidence of pathological gambling
in people on dopaminergic therapies? they were
virtually ALL on l-dopa, which  itself has a history
of being associated with hypomania - only one of the
Dodd subjects and one person in the Dodd survey of the
field were only on a dopamine agonist without l-dopa.

seems like one would have to be putting one's head
pretty deeply into the sand not to at least
*entertain* the notion that it could the *combination*
of the two that is responsible for this up-blip in the
incidence of gambling

i guess i will have to ask the lead investigator on
the study. Will also try to find out who paid for it,
just for kicks.

-- "M.Schild" <[log in to unmask]> wrote:

> >   In the study that came out in 2003, 1.5% of the
> people who were put on
> > mirapex developed serious gambling addictions -
> that is "only slightly
> > higher than the reported rate in the general
> population, which ranges from
> > 0.3 to 1.3%." does anyone know if that is even
> statistically
> >
>
significant?(http://www.abc.net.au/science/news/health/HealthRepublish_9224
> >60.htm)
>
> Significant or not, knowing that additive
> comportments can be due to an
> agonist is very useful. Particularly if these
> pathological behaviours are
> dose related and reversible. Some PWPs have
> committed suicide because of them
> and knowing the cause could have been an agonist
> could have spared lives and
> families from falling apart.
>
> >   by contrast, 100% of early onset folks put on
> l-dopa will develop both
> > dyskinesias and on/off fluctuations within 6 years
> (see Quinn, Young Onset
> > Parkinson's Disease, 1987, Movement Disorders,
> Vol. 2, no.2, p. 73-91) and
> > 75% of people put on l-dopa "will no longer have a
> smooth, stable and
> > effective response" after five years of treatment
> - in other words, 75%
> > overall will develop dyskinesias and on/off
> fluctuations within five years
>
> Sooner or later you have to choose some meds. John
> went for 10 years without
> them then started on Requip only, added sinemet
> later and now has dropped
> Requip. His attention is much better since he
> stopped the Requip. After
> 6-years of treatment , he started having on/off
> fluctuations and now ( 7th
> year) has some dyskinesias.
>
> >   if anyone has any thoughts on the subject, i
> would love to hear them. i
> > simply cannot understand how a drug that has such
> a gargantuan chance of
> > leaving people with disabling side effects has
> been "the gold standard"'
> > for about 40 years.
>
> PD before ldopa was much worse. We all hope some new
> approach will come soon
> but meanwhile....you have to try to find what´s best
> for you
>
> Maryse cg JOhn 76,16
>
>
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