Parkinson's drugs up risk of compulsive behavior: review

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Dopamine agonists, commonly prescribed to help control tremors and other symptoms of Parkinson's disease, have been linked to impulse control disorders such as pathological gambling, compulsive buying, binge eating and hypersexuality in some people, detail neurologists in a new article in Expert Review of Neurotherapeutics. If not treated, the disorders can result in serious personal and financial consequences, they add.

One large, national study found that approximately 14% of people who have Parkinson's disease exhibit at least one type of impulsive behavior, say the scientists, who are from Loyola Medicine and the Loyola University Chicago Stritch School of Medicine. The disorders are more common in men, who when affected frequently display hypersexuality or pathological gambling, whereas women who have an impulse control disorder are more likely to compulsively eat or shop.

Although dopamine agonists such as pramipexole (Mirapex) and ropinirole (Requip) are the primary risk factor for the behaviors, other risk factors include younger age, smoking, alcohol abuse and personality traits such as impulsivity, obsessive-compulsive disorder, depression and anxiety, according to the researchers.

No treatment guidelines are available, but some options include changing the dosage of someone's current medication or switching to a new medication, discontinuing Parkinson's medications or trying deep brain stimulation or cognitive behavioral therapy, the authors write. Antidepressants, atypical antipsychotics and antiepileptic drugs also may help control behaviors.

Families also play a critical role, they say. Spouses and other family members should be warned that their loved one's Parkinson's medications may cause impulse control disorders. Families should report any “unexplained absences, changes in routine behaviors, irritability, hiding evidence of the impulse control disorders and monetary consequences” to the person's care provider, the authors write. Family members also may consider limiting access to bank accounts, credit cards and the internet.

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