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"All he thinks about is sex. And playing the ponies." - (8/20/2019)

By Dr. Ron Gasbarro

Lately, the pharmacist has heard reports of unusual conduct by some of his patients. For instance, Harvey has developed a bad gambling habit. Says his wife, “He practically lives at the track. Now, the mortgage money is gone. We may lose our car and maybe the house. How did this happen?” Sherry cannot stop shopping. Whether it is QVC, eBay, or hitting the malls, she cannot stop buying things. Most of her purchases have never been opened. He husband said, “Sherry used to be so good with money. Now our credit cards are maxed out. I am afraid our credit score is going into free-fall.” Jim has been married for 15 years. His wife thought he was happy but lately, she discovered he hangs out in Internet sex chat rooms. He has started to lie to her. “He is totally preoccupied with sex,” she says. “He has distanced himself from the kids, his tennis buddies. He fights with me and then takes off in the car.”

In addition to exhibiting bizarre conduct, Harvey, Sherry, and Jim have one more thing in common: each of their doctors has recently prescribed them a medication from the same drug class – the dopamine agonists. Dopamine is a neurotransmitter - a chemical found in the brain. Humans, and many animals, use dopamine to transmit information. Example: The brain uses it to send signals to the muscles in the body to make them move properly. When the body has insufficient dopamine, the muscles do not work adequately, resulting in an illness such as Parkinson’s disease, a movement disorder. 

Dopamine can also affect the way we feel. This neurotransmitter helps control the brain's reward and pleasure centers. In fact, dopamine enables us not only to recognize rewards (e.g., see the chocolate cake), but also to act on them (eat the chocolate cake). In major depression, the person with depression suffers from reduced motivation and takes no pleasure from the things he once liked (ignore the chocolate cake). These symptoms are consistent with low levels of dopamine. 

Enter the dopamine agonists. An agonist is a substance that initiates a physiological response when combined with a receptor. Thus, dopamine agonists act as a substitute for dopamine that can jump-start the dopamine receptors in the brain. These drugs are used in Parkinson’s disease, restless leg syndrome, depression, and even schizophrenia. And they can improve the quality of life in those taking them. However, they have also been implicated in strange psychological side effects, such as compulsive gambling, shopping, tanning, eating disorders (eat all of the chocolate cake), multi-orgasmic sexual activity, and pornography obsession. 

This is why patients should read the package inserts that come with the medication. One insert states, “Some people taking [Drug X] have had unusual urges, such as gambling, binge eating or eating that you cannot control, compulsive shopping and sexual urges. In some cases, although not all, these urges were reported to have stopped when the dose was reduced or the medication was discontinued.” 

Because patients may not recognize these behaviors as abnormal, prescribers and pharmacists must ask patients or their caregivers about the development of new or increased urges while being treated with a dopamine agonist. In the past, compulsive gamblers were considered “bums” who bet and lost the family rent money. Sex addicts were called “sluts” and “perverts.” Now that we can better pinpoint the cause, specifically if the patient is taking a dopamine agonist, such individuals struggling with patterns of addictive and self-destructive activities can be successfully treated rather than shamed. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com

 


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