The last set of posts have brought stimulants and dopamine into the frame. In the 1960s and 1970s while stimulants were becoming controlled drugs it was nevertheless denied that they caused dependence.
It is now clear that the closely related dopamine agonists, increasingly the first line treatment for Parkinson’s Disease, cause a host of compulsive behaviors in addiction to marked dependence and a debilitating withdrawal problem – Dopamine Agonist Withdrawal Syndrome (DAWS).
There were early RxISK posts on the compulsive behaviors linked to dopamine agonists and on DAWS, with the DAWS post attracting a lot of comment. There are also RxISK guides on Dopamine Agonists for Takers and Dopamine Agonists and Parkinson’s Disease.
There was an early RxISK story linking antidepressants like Venlafaxine to compulsive behaviors – Gambling on Antidepressants, and there will be posts on Abilify covering similar ground in weeks to come.
The compulsive behaviors lead to High Court Judges and other paragons of society engaging in risky behaviors like gambling, and promiscuity and also as the post below from the Parkinsons’ Society of Ireland shows a range of Punding behaviors. Punding as Johanna Ryan noted last week was widely recognized in the heyday of the stimulants.
These compulsive behaviors are certain to lead to radical changes in medico-legal understandings about the effects of both drugs and insanity on behavior. As things stand, faced with compulsive behaviors, the police and courts turn to standard insanity defenses, but there is a difference between being poisoned and being insane. Under the influence of these drugs many people can still distinguish right from wrong but are helpless to prevent themselves behaving in horribly destructive ways.
These behaviors resemble that shown by junkies with one exception – High Court Judges don’t mug people or engage in crime to feed their habit because their doctor is a free and easy source of supply.
The material here comes from a piece written by Sean o’Sullivan for the Parkinson’s Society of Ireland, which can be accessed in its original form here.
Compulsive behavior is characterized by an inability to resist an impulse or temptation, so the person can’t stop themselves from doing an activity repeatedly, excessively or obsessively. In most cases it is the family members who describe the full social and functional impact of these behaviors on the persons’ lives.
Whilst some behaviors are associated with increased amounts of dopamine-replacement therapies, in most cases the behavior develops in people taking standard doses. It is estimated that up to 14% of people with Parkinson’s taking dopamine agonists experience some problem with impulsive-compulsive behaviors. In a lot of cases, the behavior is out of character for the person. If untreated, they can escalate and lead to uncontrollable addictions that devastate people’s lives.
What kind of impulsive – compulsive behaviors are seen in Parkinson’s?
The most frequently described behaviors include compulsive gambling, compulsive sexual behavior, compulsive shopping and binge-eating or compulsive eating. It is quite common for an individual to have more than one type of impulsive-compulsive behavior.
These behaviors manifest as:
Some people with Parkinson’s become addicted to their dopamine replacement drugs. This behavior is less frequently seen than compulsive gambling, compulsive sexual behavior, compulsive shopping and binge-eating or compulsive eating.
Here, the addiction is so powerful that they start taking more and more of the drug – exceeding the dose prescribed to control their movement. This happens even though they are ‘on’ and experience severe dyskinesia (involuntary jerking). People will often resist the advice of their doctors and families when it is suggested that they try and reduce their dopamine medications.
People with this problem may also have very bad mood swings throughout the day. These can vary from feelings of depression, irritability and anxiety when they are ‘off’, all the way to euphoria and hyperactivity when they are ‘on’.
Punding is a term used to describe repetitive and pointless activities seen in some people with Parkinson’s. Punding includes repetitive manipulations of technical equipment (eg. dismantling and re-assembling household appliances), the continual handling and sorting of common objects, grooming, pointless driving or walkabouts, prolonged monologues devoid of content, excessive cataloguing and computer work.
A feature of punding is that it is never ending, it is disorganized and frequently leaves chaos in its wake. Punding can cause social avoidance, severe sleep deprivation, and disintegration of family relationships.
Excessive hoarding is commonly seen in association with other impulsive-compulsive behaviors in Parkinson’s, and this can represent a significant health hazard to some individuals in terms of fire risk and clutter in the home.
Editorial Note: These new developments shed light on the use of stimulants. There are likely many people out there with difficulties on either dopamine agonist or stimulants – all accounts of what happens on these drugs are hugely important. Please write in.
Illustration: Betting your brains on antidepressants, 2012 © Billiam James