Among the medications used to treat Parkinson’s, a dopamine agonistA medication that acts in the brain much like dopamine does. It is used on its own or alongside levodopa, and is known to carry a clearly higher risk of impulse control disorders than levodopa.Learn more can lead some people to develop an impulse control disorder (ICD)Being unable to stop a behavior that is harmful or could become harmful. Carrying out the behavior is reported to bring a feeling of relief from anxiety or tension.Learn more. The difference is stark: against a rate of 12% in people who have never taken a dopamine agonistA medication that acts in the brain much like dopamine does. It is used on its own or alongside levodopa, and is known to carry a clearly higher risk of impulse control disorders than levodopa.Learn more, some studies have reported rates as high as 52% among those who do.
What it looks like
The four most commonly reported forms are compulsive gambling, excessive shopping, binge eating and heightened sex drive. More than 25% of those affected are known to experience two or more of these at the same time. In severe cases, gambling or shopping can cause financial damage serious enough to end in bankruptcy.
Why it is hard to notice in yourself
An impulse control disorder is a particularly hard symptom for people with Parkinson’s to recognize in themselves. It feels like “just doing what I want to do,” so it often isn’t taken as a problem at all, and frequently the person has no idea the behavior is a symptom of the condition. In practice, that means it is often a family member or spouse who first notices an unusual spending pattern or change in behavior and raises it with the doctor.
Signs family can watch for
- A large increase in time spent on gambling or online shopping compared with before
- Spending that has risen noticeably, or is being hidden
- A sudden large increase in how much they eat, or episodes of binge eating
- Sexual interest or behavior that is out of character
If changes like these line up with the point at which a dopamine agonist was started, it is worth treating that as a possible medication side effect rather than a coincidence.
When to watch especially closely
The following are reported to carry a relatively higher risk of an impulse control disorder, so it is worth watching more carefully from the moment the medication starts.
- Diagnosed at a relatively young age
- Male
- A history of depression
- A history of other addiction problems in the past, such as alcohol or gambling
Some people try to increase their own dose
Rarely, some people start taking more medication, more often, than they were prescribed. This is called dopamine dysregulation syndromeTaking more medication, more often, than prescribed. It can show up as becoming anxious when a dose is reduced, or secretly taking extra, and it often occurs alongside an impulse control disorder.Learn more, and it can show up as becoming anxious when someone tries to reduce the dose, or secretly taking extra. It sometimes comes together with pundingRepeating the same behavior with no particular purpose — collecting things, or taking them apart and reassembling them. It is known to appear more often at higher doses of dopamine medication.Learn more, repeating the same behavior over and over with no purpose. This too is not weak willpower but the effect the medication has on the brain’s reward circuit, so rather than hiding the medication or arguing about it at home, it is safer to work with your care team on adjusting how it is taken.
What you can do now
If you notice changes like these, what matters is that neither you nor your family feels embarrassed or hides them — tell your care team. In most cases, adjusting the type or dose of the medication is known to reduce the symptoms. The earlier it is spotted and addressed, the less financial and relationship damage it can do.
This article is not a substitute for medical diagnosis or treatment. If you notice changes like these, please talk with your care team.
