Parkinson’s Medication
and Behavioural Change
Exceptional healthcare, personally delivered
Parkinson’s Medication and Behavioural
Change
The purpose of this leaflet is to inform people with Parkinson’s,
relatives and health care professionals of a particular rare side effect
associated with some treatments for Parkinson’s disease.
The brain is very complex with numerous systems interconnecting.
Consequently, a treatment exerting positive effects on one aspect of
brain functioning may have a negative effect on another brain region.
Dopamine is the key chemical messenger implicated in Parkinson’s
disease. In addition to its role in regulation of movement, dopamine
is known to play a role in brain systems involved in the reward,
reinforcement and learning of behaviours.
Several scientific studies have reported an association between certain
treatments for Parkinson’s and compulsive behavioural disorders (in
patients with Parkinson’s Disease).These compulsive disorders are
thought to be very rare side effects of dopaminergic medications.
Studies suggest these side effects of treatment occur in between
4-8% of patients taking these medications. It is thought that most
of the treatments for Parkinson’s can cause these side effect, but it is
primarily the class of drugs known as dopamine agonists (for example,
Ropinirole (Requip) and Pramipexole (Mirapexin) and Rotigotine
(Neupro)), which have been shown to cause altered behaviour. These
side effects are usually not seen in patients who are taking only
levodopa-based drugs (such as Sinemet/Co-Careldopa and Madopar/
Co-Beneldopa).
The most common behavioural changes documented to date are:
nn Gambling (including online gambling using the internet). Very
significant amounts of money have been lost.
nn Excessive interest in sexual matters and thoughts, including
looking at pornography on the internet.
nn Compulsive shopping, which may result in significant debt.
nn Over eating.
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Parkinson’s Disease and behaviour changes due to medication
Often, such behaviours will only occur on a high dose of the particular
drug, but this is not always the case. In our experience when
the “offending” medication has been reduced or stopped these
behavioural side effects have stopped. If the medication concerned
needs to be reduced or stopped other Parkinson’s drugs may be able
to be added to a person’s medication regimen in order to prevent a
worsening of movement and other Parkinson’s symptoms.
What can be done to help?
It is important that if a person experiences any of the above alterations
in their behaviour that they report this to a healthcare professional,
preferably their GP, hospital doctor for Parkinson’s or Parkinson’s nurse
as soon as possible so that they can talk about the problem and the
options for managing the problem can be discussed. People with
Parkinson’s should not stop their Parkinson’s medications without first
discussing this with their Doctor.
Health care professionals involved can offer advice and support
and more expert help can be sought from the various specialist
organisations listed below. Thesebehaviours can be extremely
distressing not just for the person with PD but also their spouse/partner,
other family members and close friends.
All of these behaviours are considered to be rare. This leaflet should
therefore be a source of information to make you aware of these rare
behavioural changes. The vast majority of people on treatments for
their Parkinson’s will not experience such side effects of the medication.
Sources of help:
nn Your GP.
nn Your Parkinson’s nurse specialist.
nn Your hospital specialist/Consultant for PD.
The Doctor/Nurse or any person who has experienced any of these side
effects can report this to the UK’s regulatory body so that the incidence
of such side effects can be monitored. This notification is called yellow
card reporting. Address: Medicines and Healthcare products Regulatory
Agency, CMH Freepost, London, SW8 5RR.
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References and Further Information
The Parkinson’s Disease Society
Helpline: 0808 800 0303.
Email: enquiries@parkinsons.org.uk
Website: www.parkinsons.org.uk [accessed August 2007]
The Parkinson’s Society has produced information sheets on
compulsive behaviours, hypersexuality and gambling.
GamCare
Tel: 0845 6000 133 (local rate) 08.00 - 24.00
2-3 Baden Place, Crosby Row, London, SE1 1YW
Email: help@gamcare.org.uk
Website: www.gamcare.org.uk [accessed August 2007]
This service offers information, advice and counselling for
people affected by a gambling dependency.
Gamblers Anonymous
Tel: 08700 508880
PO Box 88, London, SW10 03U.
Website: www.gamblersanonymous.org.uk The Doctor/Nurse
or any person who has experienced any of these side effects
can report this to the UK’s medicine regulatory body so that
the incidence of such side effects [accessed August 2007]
Helpline for people who are compulsive gamblers; also run selfhelp
groups and separate meetings for spouses, friends/families
who are affected by gambling.
The British Association for Sexual and Marital Therapy
PO Box 13686, London, SW20 9ZH.
Website: www.basrt.org.uk [accessed August 2007]
Avon Counselling and Psychotherapy Service
Tel: Bristol 930 4447
Consumer Credit Counselling Services
Tel: 0800 1381111
Offer free impartial advice to people with debt problems via
telephone counsellors.
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Parkinson’s Disease and behaviour changes due to medication
Gallagher, D.A., O’Sullivan, S.S., Evans, A.H. et al. (2007)
Pathological Gambling in Parkinson’s Disease: Risk Factors and
Differences from Dopamine Dysregulation. An Analysis of
Published Case Series. Movement Disorders, 22 (12), 17571763.
Grosset, K, Macphee, G, Pal, G, Stewart, D, Watt, A, Davie, J &
Grosset, D.G (2006) Problematic Gambling on Dopamine
Agonists: Not Such a Rarity. Movement Disorders, 21 (12), 22062208.
Lawrence, A.D, Evans, A.H & Lees, A.J. (2003) Compulsive use
of dopamine replacement therapy in Parkinson’s disease:
reward systems gone awry? The Lancet Neurology, 2, 595-604.
Weintraub, D, Siderowf, A.D, Potenza, M.N, Goveas, J, Morales,
K.H, Duda, J.E, Moberg, P.J & Stern, M (2006). Association of
Dopamine Agonist Use With Impulse Control Disorders in
Parkinson’s Disease. Arch Neurol, 63, 979-973.
Patel, N.K., et al. (2002) MRI-directed subthalamic nucleus
surgery for Parkinson’s disease. Stereotact Funct Neurosurg, 78
(3-4), 132-45.
Patel, N.K., et al. (2003) MRI directed bilateral stimulation of
the subthalamic nucleus in patients with Parkinson’s disease.
Journal of Neurol Neurosurg Psychiatry, 74 (12), 1631-7.
Terao, T., et al. (2003) Hemorrhagic complication of stereotactic
surgery in patients with movement
NHS Constitution. Information on your rights and responsibilities.
Available at www.nhs.uk/aboutnhs/constitution
Parkinson’s Disease and behaviour changes due to medication
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www.nbt.nhs.uk
If you or the individual you are caring for need support reading
this leaflet please ask a member of staff for advice.
© North Bristol NHS Trust. This edition published May 2014. Review due May 2016. NBT002051