Compulsive gambling. Persistent out-of-control shopping sprees. Hypersexuality. Chronic binge eating. These conditions, known as Impulse Control Disorders (ICD), occur for many Parkies, and it’s mostly based on what medicines they’re taking.
Dopamine agonists are the main culprits, but here’s a list of specific medicines that I culled from a handful of recently-published research articles (listed at the bottom of this page):
- Ropinirole
- Pergolide
- Entacapone
- Zonisamide
- Istradefylline
- Amantadine
- Rotigotine
There are probably more meds that I missed.
What else did I learn from the below articles? Let me enumerate:
- Pergolide is no longer used in the United States, but is still in use in many other countries.
- You are more likely to develop an impulse control disorder if you’re a Young Onset Parkie than if you’re diagnosed when you’re older.
- The impulse control disorder is influenced by your gender: men are more likely to to become hypersexual and compulsive gamblers; women are more likely to binge shop and binge eat.
- There’s a direct correlation between how much of the medicines listed above you’re taking and how serious your impulse control disorder can get.
- If you stop taking the medicines, the compulsive behaviors will fade away.
- Deep brain stimulation can also produce impulse control disorders.
- You’re more likely to develop ICDs if you currently smoke cigarettes or did so in the past.
- In one study that followed patients over five years, 51% of Parkies who had used dopamine agonists went on to develop ICDs, vs. 12% of Parkies who never used those drugs.
- You’re more likely to develop an ICD if you’re single (i.e., not married).
Here’s my personal saga of my experience with ropinirole and amantadine:
For the first few years after I was diagnosed with PD, I was on various drugs and saw no bad side effects. When my neurologist started me on ropinirole and amantadine a year or so ago, I suddenly found that I was ravenously hungry within a few hours after eating a normal, big meal. For example, on weekdays I ate breakfast at 5:00 a.m., then by 7:00 my stomach was empty and I craved protein. So I’d eat a protein bar or a peanut butter sandwich on whole grain bread. But then the hunger would return at 10:00, and I’d eat another protein bar to hold me over until lunch.
This continued all day. It was a physical sensation of intense hunger that drove me to eat so much. My stomach grew larger and larger until it looked like I had swallowed the kitchen sink. I couldn’t button my pants. I couldn’t wear medium-sized T-shirts anymore, and switched over to large. And I was not happy about it.
I still worked out at the gym, still swam. But my belly was enormous, and I had gained about 15 pounds.
I discussed this with my neurologist; she cut back the dosages. Now I’m getting thinner again and have no problems buttoning my pants. The hunger pangs are very weak now, and often I can go the whole morning without feeling the need to eat.
Phew!
I’d like to add one sidebar to this post. It concerns other side effects from dopamine agonists. Here’s a direct quote from the abstract of one of the papers I read:
Impulse control disorders (ICDs), such as compulsive gambling, buying, sexual, and eating behaviors, are a serious and increasingly recognized complication in Parkinson’s disease (PD), occurring in up to 20% of PD patients over the course of their illness. Related behaviors include punding (stereotyped, repetitive, purposeless behaviors), dopamine dysregulation syndrome (DDS) (compulsive medication overuse), and hobbyism (e.g., compulsive internet use, artistic endeavors, and writing). These disorders have a significant impact on quality of life and function, strain interpersonal relationships, and worsen caregiver burden, and are associated with significant psychiatric comorbidity.
“Hobbyism”? Compulsive artistic endeavors and compulsive writing? Help! Do I have that, too? (Example: 100 Haiku about Parkinson’s Disease)
Here’s what I read before writing this post:
- Dopamine Agonists Associated With Impulse Control Disorders in Parkinson Disease
- Risk Factors for Impulse Control Behaviors in Parkinson Disease
- Parkinson’s Medications Tied to Impulse Control Disorders
- Impulse Control and Related Disorders in Parkinson’s Disease
