Impact of Dopamine Agonists on Compulsive Behaviors: A Case Series of Pramipexole-Induced Pathological Gambling

• Published in: Psychosomatics (Washington, D.C.) D.C.), 2010-05, Vol.51 (3), p.271-273
• Main Authors: Kolla, Bhanu Prakash, M.D, Mansukhani, Meghna Prabhdas, M.D, Barraza, Roma´n, M.D, Bostwick, John Michael, M.D
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aged; Benzothiazoles - adverse effects; Benzothiazoles - therapeutic use; Biological and medical sciences; Compulsive Behavior - chemically induced; Compulsive Behavior - diagnosis; Compulsive Behavior - psychology; Depressive Disorder - diagnosis; Depressive Disorder - psychology; Disruptive, Impulse Control, and Conduct Disorders - chemically induced; Disruptive, Impulse Control, and Conduct Disorders - diagnosis; Disruptive, Impulse Control, and Conduct Disorders - psychology; Dopamine Agonists - adverse effects; Dopamine Agonists - therapeutic use; Drug toxicity and drugs side effects treatment; Gambling - psychology; Geriatrics; Humans; Indoles - adverse effects; Indoles - therapeutic use; Internal Medicine; Male; Medical sciences; Middle Aged; Miscellaneous; Miscellaneous (drug allergy, mutagens, teratogens...); Pharmacology. Drug treatments; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Restless Legs Syndrome - drug therapy; Suicide, Attempted
• ISSN: 0033-3182; 1545-7206
• DOI: 10.1016/S0033-3182(10)70695-2

Background Dopamine agonists (DAs), long used in treating Parkinson's disease and effective in relieving symptoms of restless legs syndrome, have frequently been reported to induce problematic compulsive behaviors (e.g., obsessive gambling, hypersexuality) in individuals who had never had difficulties with such behaviors before. Objective The authors report two cases that add to a small-but-growing literature suggesting that these drugs be dispensed with appropriate caution. Method The authors describe two patients seen in a psychiatric setting—one, after a suicide attempt, and one with depression—both resulting from intractable compulsive gambling. Results In both instances, control of gambling was achieved: in one, when pramipexole was discontinued, and in the other, after substitution of ropinirole and addition of spiritual and support-group approaches. Discussion DAs stimulate pathways that govern reward behavior, including pleasure and addiction. Other reward behaviors, such as eating and sexual activity, may also be affected by DAs. These cases demonstrate a clear temporal relationship between initiation and behavioral change; patients and their caregivers should be alerted to the possibility of such changes.