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 > > ---------------------------------------------------------------------- > To sign-off Parkinsn send a message to: mailto:[log in to unmask] > In the body of the message put: signoff parkinsn > > ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn