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Drug tied to compulsive behavior

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Posted: Sunday, September 25, 2005 5:45 am | Updated: 7:51 am, Fri Oct 7, 2011.

On Brian Hearn’s desk at home, there’s an empty space where his computer used to be.

Hearn’s family took his computer away about five months ago, after he lost his retirement savings — nearly $250,000 — gambling on the Internet.

Ashamed and confused about his overwhelming urges to gamble, Hearn told his doctor, who immediately dropped his dose of Mirapex, a drug that helped his Parkinson’s disease symptoms.

Suddenly, the 59-year-old didn’t feel like gambling anymore.

"All my gambling urges went away immediately, but I was $250,000 in the hole," he said. "When you’re retired and have Parkinson’s, there’s not a whole lot you can do about (the losses)."

Hearn is one of a growing number of people who believe that Mirapex, a drug used successfully to control the tremors and stiffness of Parkinson’s disease, turned them into compulsive gamblers. Increasingly research backs them up.

Neurologists who treat hundreds of patients with the movement disorder have found that in about 1.5 percent of people, Mirapex, also known as pramipexole, triggers compulsive behaviors — especially gambling.

That number is probably much bigger, doctors said, because patients are too embarrassed to admit they have become consumed by the drive to gamble, eat, shop or have sex. Lawyers say hundreds of patients with Parkinson’s disease — including Hearn — are trying to join lawsuits filed in Canada and California alleging that the drug’s manufacturer, Boehringer-Ingelheim Pharmaceuticals Inc., failed to adequately warn patients about potential side effects.

"We actually think it’s underreported," said Dr. Erika Driver-Dunckley, a neurologist at Mayo Clinic Scottsdale who researched the connection between Mirapex and pathological gambling. "Now that we have started asking more, we’re starting to get more information from patients."

The result is group of people who have become the unlikely victims of compulsive behaviors. Their experience is now a window into what can trigger the brain to act compulsively.

The findings also have prompted warnings from both Boehringer-Ingelheim, which added information about compulsive behaviors to the package insert of prescriptions last year, and from doctors when they put patients on Mirapex.

"It’s unbelievable," said Hearn, sitting at the empty desk in his Phoenix home. "It just grabs you and wraps you up."

STRAIGHT-LACED PATIENTS

Hearn was not the type of person to take chances. An electrical engineer for Motorola, Hearn retired in 1999 with equity in his home and a healthy 401(k) fund balance. Anticipating grandchildren, Hearn spent about nine months building a kid-sized train and a track they could ride around his house.

But Hearn’s life became his own train wreck of sorts after his doctor put him on Mirapex in 2002. One month after he was ramped up to his full dose of the drug, Hearn began using his mouse to click away $100 bets or more on Internet gambling sites every chance he could.

His wife, Bettianne Hearn, watched him get up night after night to use the computer. She saw the enormous credit card bills and gifts from Internet gaming companies come in the mail, and she saw her husband turn into a different person.

"I was in a world of my own," Hearn said. "Instead of being in control, I was watching on the sidelines. That’s not me. Anyone who knows me knows how conservative I am."

For Parkinson’s disease sufferers to be acting compulsively was a big tip-off that something wasn’t right, said Driver-Dunckley. Such observations led to her research and other studies of Parkinson’s patients and their use of a popular class of drugs called dopamine agonists.

"Typically, patients with Parkinson’s disease aren’t gamblers, they are really straight-laced people," said Driver-Dunckley. "The classic person with Parkinson’s disease never smoked, never drank, are engineers, analytical, worked hard. For them to be going out and spending hundreds of thousands of dollars gambling, why would they do that?"

Driver-Dunckley’s research, which was done while she was a resident in 2002 at the Muhammad Ali Parkinson Research Center at Barrow Neurological Institute in Phoenix, found that out of 1,884 Parkinson’s patients receiving dopamine agonist therapy, nine had symptoms of obsessive or excessive gambling. Eight of the gamblers were taking Mirapex.

Researchers at Mayo Clinic in Rochester, Minn., identified 11 patients with Parkinson’s disease who became compulsive gamblers, including six patients who developed other compulsive behaviors involving eating, spending, alcohol or sex. Nine of the patients were on Mirapex.

While the numbers are small, researchers in both studies point to the fact that in most of the patients, pathological gambling stopped soon after they either stopped taking the drug or their dosage was reduced.

"The relationship of pathological gambling to dopamine therapy in these cases is striking," according to the Mayo Clinic study.

But a spokeswoman for Boehringer-Ingelheim said the jury is still out on what, if any, that relationship is.

"So far, there is no conclusive scientific evidence of a causal relationship between pramipexole and compulsive behavior, but we did decide to include wording on our package insert that we’ve seen rare reports of that behavior," said Kate O’Connor of Boehringer-Ingelheim. "We were proactive about it so physicians and patients can make informed decisions."

The manufacturer’s warning, however, was too little too late, said Daniel Kodam, an attorney who has filed a lawsuit in California on behalf of several plaintiffs who say Mirapex led to their compulsive gambling. Kodam said about 450 people have expressed interest in joining the case, which awaits class-action certification.

"I think what they did was a joke," Kodam said of the warning, which appears toward the end of a long package insert. "It’s barely there. Doctors need to be notified and told this is something that can happen."

More than 6 million prescriptions for Mirapex have been written since the drug was launched in 1997, said O’Connor.

GAMBLING PREFERENCE

To some neurologists and addiction specialists, the idea that dopamine agonists such as Mirapex somehow lead to compulsive behaviors is not surprising. The dopamine receptors stimulated by Mirapex play a role in movement and mobility. But the receptors are in a region of the brain associated with emotions, including pleasure and rewardseeking behavior. Researchers suspect that by targeting this region, drugs such as Mirapex may have something to do with compulsive behaviors.

Medical authorities have long known that dopamine, which Mirapex mimics, is affected by cocaine use, and the same holds true for gambling, said Christine Reilly, executive director of the Institute for Research on Pathological Gambling and Related Disorders at Harvard Medical School.

"There definitely is a neurobiological component" to addiction, she said. "There’s no reason (gambling) would be any different."

It is still unknown what drives a person to one type of compulsive behavior over another; or in the case of Mirapex, why most patients who developed a compulsion chose gambling, authorities say.

Other factors could include proximity to casinos, the degenerative effects of Parkinson’s disease or an individual’s propensity for certain behaviors.

The incidence of gambling addiction was about the same among Parkinson’s patients on Mirapex as it is in the general population.

Dr. Richard Burns, director of the Parkinson’s and movement disorders program at Barrow Neurological Institute, said compulsive gambling among patients on Mirapex is an "idiosyncratic response" rather than a predictable side effect.

"I’m convinced that Mirapex triggers it or precipitates it, but I’m not convinced that the gambling instinct is in the pill," he said.

Hearn said there is no doubt in his mind that Mirapex is to blame for his gambling losses. Since reducing his dosage, Hearn has used all the money in his 401(k) fund and refinanced his home to pay off his debts.

"I haven’t had one urge," he said. "I still see a gambling counselor, but we don’t have anything to talk about."

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