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. Method: 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. Discussion: 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.