In my last blog, I discussed how PD dopamine agonists can cause compulsive behaviors in some patients. A recent study suggested that this could occur in as many as 13% of patients taking these drugs. I would now like to look at signs that should trigger concerns about compulsivity.
Any behavior that seems to have taken on a life of its own should trigger an evaluation for compulsivity. Endless hours at the computer to the exclusion of time with the family would be one example; hypersexuality another. So would purchases of reams of lottery tickets or an enthusiasm for the daily trading of financial instruments. Many activities would not typically be considered compulsive because they result in positive outcomes. For example, compulsive cleaning or yard work can produce a tidy, well-kept home. But if these behaviors are relatively new or have become exaggerated over time, there is likely to be a problem.
Another warning sign for compulsivity is a feeling of unease, anxiety, or irritability when the activity is stopped. When a behavior has received consistent reinforcement, the expectation for reward is high and the disappointment with its absence can be pretty compelling. Compulsive behaviors are typically marked by an internal drive to engage in the activity because there is a strong expectation that a rewarding outcome will follow. When the drive is thwarted by family or circumstances, a person with compulsivity concerns may become restless and moody, even visibly agitated. This is a hallmark sign of a problem.
Furtiveness is another strong sign that behavior is becoming problematic. The compulsive eater who smuggles sweets into the home and the person surfing porn sites when the family sleeps are good examples. If discovered and confronted, the person engaging in this behavior may become defensive or angry, perhaps denying the behavior all together. This presentation may be particularly corrosive to family relations because a person hiding their compulsivity may do tremendous damage before being caught. I have dealt with several cases of retirement funds being tapped out to make up gambling losses.
There is another problem with dopamine agonists that does not get a lot of discussion. They have at least some potential to alter mood and have actually demonstrated some anti-depressant qualities. There have been reports of some individuals compulsively abusing these drugs because they enjoy the feeling it provides. Thus, use of the dopamine agonists may become compulsive in and of itself.
Because it is so hard to predict who might respond to PD dopamine treatments compulsively, it is imperative that a person taking them monitor his or her behavior rigorously and honestly. However, it is important to remember that self-deception can be a problem for the best of us. It never hurts to engage a family member or trusted friend as a backup. No one sets out to have a problem with a drug they are taking to manage a medical condition. However, if these meds do become a problem, the burden of responsible use falls on the patient. Telling your healthcare provider and family about your behavior is the best course of action.