The study results reflect that although dopamine medications (such as Mirapex, Requip and Neupro) are essential to treating Parkinson’s Disease (PD), the challenge is to find a balance between high and low levels of dopamine. Long-term exposure to dopamine medications, especially dopamine agonists (DAs), can cause a hypersensitivity to dopamine. The body overreacts, and this in turn can lead to an impulse control disorder(ICD) — a group of behaviors that includes gambling, uncontrollable shopping, compulsive eating, a sudden obsession with sex, punding (stereotypic, complex, and repetitive behavior involving meaningless activities) — as well as a related disorder, excessive daytime sleepiness.
Impulse Control Disorders, Up Close and Personal
Interestingly, Daniel Weintraub, MD, associate professor of psychiatry and Neurology at the Perelman School of Medicine at the University of Pennsylvania, says that ICDs are most likely to manifest in men as gambling and hyper sexuality, whereas in women it expresses as shopping and overeating.
Needless to say, these compulsive behaviors can have serious repercussions.
“I’ve seen marriages break up and lives ruined as a result of dopamine agonists,” says Howard Weiss, director of the Parkinson’s Disease and Movement Disorder Programs at the LifeBridge Health Brain & Spine Institute in Baltimore. “I’ve had at least three patients who have lost their homes because of bankruptcy after taking the drugs. It sounds like a joke, but it’s not.”
What’s more, ICDs are shockingly common. Weintraub cites a study that demonstrated about 14% of people with PD experience 1of 4 of the typical ICD behaviors. He says his own guess is more like 17% to 20%, perhaps even 25%.
The reason that ICD might be even more prevalent than statistics show lies in the fact that they can easily slip under a doctor’s radar. Many patients aren’t forthcoming about the symptoms, and doctors may not take the time to ask the right questions.
“Most doctors have no idea how to diagnose ICDs,” says Weiss, “and most patients are in the dark.”
He says when he asked one elderly patient taking one of the drugs if she ever gambled, she replied, “Gambling is the work of the devil.” “But she had been buying hundreds of dollars’ worth of lottery tickets a week, a habit she didn’t consider to be gambling,” he says.
At every visit, Weiss suggests, “The doctor has to ask patient and spouse about unusual behavior. A big red flag, he says, is when patients complain of not sleeping. This is normally “code” for increased computer use, which may include pornography and internet gambling, and punding (performance of repetitive, mechanical tasks). Here’s a closer look at some of the common types of ICDs.