Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease
Driver-Dunckley, E., Samanta, J., Stacy, M Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease Neurology, 2003 Aug 12;61(3):422-3
These authors suggest that patients with PD that have poor self-regulation and higher likelihood of self-medicating behaviors may be more prone to pathological gambling due to high dose therapy with dopamine. They completed a retrospective database review from 1999-2000 from the Muhammad Ali Parkinson Research Center (MAPRC). They discussed nine patients (7 men, 2 women; mean age 57.2; duration of PD 11.6 years; mean L-Dopa 883.4 mg/day) that had pathological gambling difficulties associated with their dopamine therapy. Eight patients were taking pramipexole (Mirapex; mean 4.3 mg/day; range 2-8mg/day) and one patient was taking pergolide (Permax; 4.5 mg/day). Their dopamine therapy was started on average 20.2 months prior to the onset of gambling (range 6-64 months) and in 7 of the cases gambling occurred within a month of increasing their dopamine dose. Four of the patients had a history of depression and one patient had history of panic disorder. Patients were treated in a multitude of ways, 6 patients switched to ropinirole (Requip) and 1 patient had reduced pramipexole (Mirapex) and increased levodopa. Two patients required additional psychiatric assistance including the addition of mood stabilizers. The overall incident rate of pathological gambling in the entire group of PD patients in their sample (N=1884) was low regardless of the type of therapy they were receiving (0.05%). The incident rates increased slightly with pramipexole (Mirapex; 1.5%; N=529) and pergolide (Permax; 0.3%; N=331) but were still low rates. It is notable that the incidence of pathological gambling in the general population is 0.3-1.3%. It is notable that patients were not contacted after their initial gambling difficulties to discuss the role of alcohol, smoking, drug use, obsessive-compulsive behaviors, or bipolar disorder, all of which could add to one’s risk factors for pathological gambling. These authors conclude that there are many complexities within a diagnosis of PD, including comorbid conditions, chronic illness, dopaminergic therapy, and the availability of casinos (especially aimed towards the geriatric population in retirement and vacation settings) that likely contribute to the risk factors of developing pathological gambling.