Parkinson's Drugs Linked to Impulse Control Disorders | Loyola Medicine
Wednesday, April 6, 2016

Parkinson's Disease Medications Linked to Risk of Compulsive Gambling, Shopping and Binge Eating

MAYWOOD, IL – Drugs commonly prescribed to treat Parkinson’s disease have been linked to impulse control disorders such as pathological gambling, compulsive buying, hypersexuality and binge eating in some patients, according to a review article by neurologists at Loyola Medicine and Loyola University Chicago Stritch School of Medicine.
 
These disorders can have disastrous personal, professional and financial consequences if not recognized or treated, according to the article in the journal Expert Review of Neurotherapeutics. Authors of the paper include José Biller, MD, and first author Adolfo Ramirez-Zamora, MD, who completed a residency in neurology at Loyola.
 
The paper details the latest findings for treating impulse control disorders (ICDs) in Parkinson’s disease patients, including adjusting medications, deep brain stimulation and a counseling technique called cognitive behavioral therapy.
 
One large, previous national study found that approximately 14 percent of Parkinson’s disease patients experience at least one ICD. The disorders are more common in men. Men are more likely to display hypersexuality and pathological gambling, while women are more likely to exhibit compulsive eating and buying. Potentially catastrophic consequences include financial ruin, divorce and loss of employment.
 
Patients often lack insight and underestimate the presence and severity of ICDs and related conditions, the authors write. ICDs are probably more prevalent in Parkinson’s disease patients than previously reported.
 
The primary risk factor for ICDs is the use of a class of Parkinson’s disease medications called dopamine agonists, which help control tremors and other Parkinson’s symptoms. These drugs include pramipexole (Mirapex®) and ropinirole (Requip®). Other risk factors include younger age, smoking, alcohol abuse and personality traits such as impulsivity, obsessive-compulsive disorder, depression and anxiety.
 
Management of ICDs is particularly difficult and no treatment guidelines for ICDs in Parkinson’s patients are available. Treatment should be individualized, and careful selection of specific interventions is critical. Treatments that have been considered include switching, reducing or discontinuing Parkinson’s medications. But this can be challenging. Patients often are reluctant to change medications because they do not want their tremors to get worse. Patients also can experience withdrawal symptoms when taken off dopamine agonists, including anxiety, panic attacks, depression, irritability and fatigue.
 
The authors discuss alternative treatment strategies for Parkinson’s disease and medications that may help control ICDs, such as antidepressants, atypical antipsychotics and antiepileptic drugs. Other potential nondrug treatments include cognitive behavioral therapy and a “brain pacemaker” called deep brain stimulation. The authors provide a much-needed, practical and detailed review of the factors that are important when making management decisions.
 
Families also play a critical role. Spouses and other family members should be warned that Parkinson’s medications can cause ICDs. Families should report to the patient’s physician any “unexplained absences, changes in routine behaviors, irritability, hiding evidence of the impulse control disorders and monetary consequences,” the authors write. Helpful non-pharmacological approaches include limiting access to bank accounts, credit cards and the internet.
 
Dr. Biller is chair of the department of neurology of Loyola University Chicago Stritch School of Medicine. Dr Ramirez-Zamora, a former resident in Loyola’s department of neurology, is now at Albany Medical College and serves as the Phyllis E. Duke Endowed Chair in Movement Disorders. Other co-authors are Lucy Gee of Albany Medical College and James Boyd, MD, of the University of Vermont College of Medicine.
 
Their article is titled, “Treatment of impulse control disorders in Parkinson’s disease: Practical considerations and future directions.”

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.