Drug-Induced Compulsive Behaviors: Exceptions to the Rule
To the Editor: We are intrigued by the recent article by Bostwick et al1 on the emergence of impulse control behaviors after treatment with dopamine agonists. It is amazing how these gambling and hypersexuality adverse effects occur and then seem to immediately abate simply by discontinuing the Parkinson disease medication without need for any additional addiction-related treatment. Ropinirole was recently investigated in a phase 4 clinical trial as a treatment for sexual dysfunction secondary to antidepressant pharmacotherapy,2 which speaks to its possible effects on sexual behavior. Dopamine agonists may affect the mesolimbic pathway, as do drugs like cocaine and methamphetamine, whose behavioral properties are attributed to this dopaminergic activity; sexual compulsivity is a well-established adverse effect of these medications.3 Furthermore, dopamine dysregulation syndrome, an addictive use pattern of dopamine agonists, causes the same behaviors observed in cocaine-dependent patients, such as punding, a stereotypical motor behavior...