Impact of dopamine agonists on compulsive behaviors: a case series of pramipexole-induced pathological gambling.
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.
Kolla
Bhanu Prakash
BP
correspondence and M.D., Dept. of Psychiatry, Mayo Clinic, 2nd St. Sw, Rochester, MN 55905, USA. kolla.bhanuprakash@mayo.edu
Mansukhani
Meghna Prabhdas
MP
Barraza
Román
R
Bostwick
John Michael
JM
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
D052160:Benzothiazoles; D018491:Dopamine Agonists; D007211:Indoles; C046649:ropinirole; D000077487:Pramipexole