title: Impact of dopamine agonists on compulsive behaviors: a case series of pramipexole-induced pathological gambling.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: correspondence and M.D., Dept. of Psychiatry, Mayo Clinic, 2nd St. Sw, Rochester, MN 55905, USA. kolla.bhanuprakash@mayo.edu
authors.forename: Bhanu Prakash
authors.initials: BP
authors.lastname: Kolla
authors.forename: Meghna Prabhdas
authors.initials: MP
authors.lastname: Mansukhani
authors.forename: Román
authors.initials: R
authors.lastname: Barraza
authors.forename: John Michael
authors.initials: JM
authors.lastname: Bostwick
mesh_terms: D000368:Aged; D052160:Benzothiazoles / Q000009:adverse effects* / Q000627:therapeutic use; D003192:Compulsive Behavior / Q000139:chemically induced* / Q000175:diagnosis / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000523:psychology; D018491:Dopamine Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D005715:Gambling / Q000523:psychology*; D006801:Humans; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000077487:Pramipexole; D012148:Restless Legs Syndrome / Q000188:drug therapy*; D013406:Suicide, Attempted
chemical_list: D052160:Benzothiazoles; D018491:Dopamine Agonists; D007211:Indoles; C046649:ropinirole; D000077487:Pramipexole