The Risk of Problem Gambling During Dopamine Agonist Treatment of Parkinson’s Disease: A Literature Review and Response
Student
Psychopharmacology
September 5th 2012
Abstract
Parkinson’s disease is a progressive disorder that results in both psychomotor and cognitive deficiencies. Accepted treatment for Parkinson’s is to center on the need to increase dopamine as well as promote transmission in dopamine pathways. Medications used to treat the psychomotor symptoms of Parkinson’s disease, dopamine agonists, have been researched in meeting this end. Dopamine agonists have also been seen to cause impulse control impairment which includes a breakdown of the natural risk-reward mechanisms of the brain. One impulse control problem, Pathological Gambling, has been shown to increase with taking dopamine agonists such as Paripexole. This type of behavior has been noted to cause added social dysfunction which may or may not be worth the risk depending on a patients overall dysfunction. A physician and therapeutic practitioner must be aware of this risk and be able to help guide the patient with making a decision to continue with dopamine agonist treatment. This paper views the treatment as worthwhile as psychomotor symptoms become more debilitating over time. If a client pursues dopamine agonist treatment and develops impulse control problems, then it would be apropos to treat the symptoms of that disorder as well. Client and practitioner education is essential to making the most effective and empathetic decision.
The Risk of Problem Gambling During Dopamine Agonist Treatment of Parkinson’s Disease: A Literature Review and Response One of the primary questions to ask before a doctor prescribes any medication and a patient takes this medication is if the benefits of taking the medication outweigh the risks. To effectively survey this question involves a knowledgeable prescriber and an inquisitive patient who are able to come together and agree on what the acceptable risks are when treating a particular illness.
One of the accepted treatments of Parkinson’s disease is to address the central problem of the patient’s dopamine depletion in producing motor symptoms, like tremors, and prescribe dopamine agonists that increase the reception of dopamine to alleviate debilitating parkinsonian symptoms. Dopamine agonist medications have been noted to lessen tremors as well as other Parkinsonian symptoms. However, various studies have also noted that these particular medications have been linked to impulse control problems such as problem or even pathological gambling. The patient, informed of this risk, may have a difficult decision to make when deciding to alleviate debilitating Parkinson’s symptoms at the expense of an ability to control impulses, such as gambling, that may also debilitate their quality of life. Much of the research on the link between using dopamine agonists for the treatment of Parkinson’s disease and the increase of problem or pathological gambling is controversial and has been challenged for various reasons. This paper will review and address the different sides of this debate. Preceding the discussion of this debate will provide an academic description of Parkinson’s disease, Pathological Gambling, and the role of dopamine in the motivation and reward aspects of the brain. Based on these findings, conclusions can then be made in terms of risk and benefits of taking these medications.
Description of Parkinson’s Disease Lader (2008) describes Parkinson’s disease as marked by the classic symptoms of stiffness and poverty of movement as well as body shakes or tremors, and muscular rigidity. The malady is progressive, Lader asserts in discussing how the disease effects one side of the body then spreads to the other side followed by “postural instability, orthostatic hypotension, and cognitive impairment” (p.408). Zand (2007) further describes Parkinson’s disease in a similar
