Mental Health Series: Dopamine Agonists and Compulsive Disorders – Not a Good Mix

I have several compulsive disorders: Obsessive Compulsive Disorder, Binge Eating Disorder, and Compulsive Shopping. My other disorders include Bipolar Disorder 1, Generalized Anxiety Disorder, Social Anxiety Disorder, PTSD, and more. Although, of the three compulsive disorders, Compulsive Shopping hasn’t been given an actual Mental Illness disorder designation, it is heading in that direction.

I remember back in 2008 when I realized I had a problem. I spent over $5,000.00 in one month. Most everything I bought was for my new granddaughter, but it wasn’t necessary or required. I just went in the stores, went to my happy place, and resurfaced as I left the store, wondering how I could have spent so much and why did I have so many packages and bags?

A blog post, Compulsive Shopping Symptoms and Secrets sums up the emotional aspects of why we shop:

COMPULSIVE SHOPPING SYMPTOMS

•                Compulsive shopaholics who shop when they are feeling emotional distress

•                Trophy shopaholics who are always shopping for the perfect item

•                Shopaholics who want the image of being a big spender and love flashy items

•                Bargain seekers who purchase items they don’t need because they are on sale

•                Bulimic shoppers who get caught in a vicious cycle of buying and returning

•                Collectors who don’t feel complete unless they have one item in each color or every piece of a set.

•                When they are feeling “out of sorts, shop for a ” pick-me-up.”

The blog posts goes on to identify some of the emotional symptoms identifying compulsive shopping:

•                Spending more than they can afford

•                Shopping as a reaction to feeling angry or depressed

•                Shopping as a way to feel less guilty about a previous shopping spree

•                Harming relationships due to spending or shopping too much

•                Losing control of the shopping behavior

Fast forward to this year, 2016. I have attempted to keep my compulsive shopping in check, although I still had my moments. However, this year, it went over the top out of control. My husband I moved an hour north of where we used to live in Tampa, FL, to an airport community. It was beautiful and so serene, calming, and relaxing. Everyone had the same interest; nearly every home had a hanger with a plane or three. The runway went right down the middle of the community with our roads as taxiways. I’ve developed five gardens so far in the back yard, and we have visitors such as deer, turkeys, Sand Hill Cranes, Eagles, Hawks, Falcons, rabbits, and more.

We did have to spend quite a bit of money getting the house prepared to move in as it was a foreclosure that sat empty for five years. It needed everything from air conditioning units; to appliances; to a septic tank lift station, to a hanger door. And so much more, this post could turn into a laundry list of repairs.

It took a LOT of money.

So, my husband’s idea was to put us on a budget to repay all the expenses incurred, as well as provide various categories for future spending with limits for each month.  It was something I just couldn’t grasp. I tried, every month, every week, every day, but I still was spending my budget in the first week, and moving money around to compensate for the rest of the month’s shopping sprees.

It even got to the point that one weekend, my husband wanted to Baker Act me into a psychiatric hospital to see if something seriously drastic could be done. Even if it just kept me from spending for a few days. It was a last ditch effort to stop my compulsive shopping and a way to save my husband’s own sanity.

Instead we had a very long, heart to heart talk about my feelings of being controlled by him and the budget, my feelings of not being worthy as I am a disabled Veteran and am unable to work outside of the home. What my purpose in life versus what my husband’s idea of my life purpose differed. I wanted to contribute more money to our income, but my husband felt that my mental health was more important, and I didn’t need to work, he’d rather I didn’t, and he preferred that I take care of the house, the pets, the gardens, and relax.

I just couldn’t do that.

So, he accompanied me to my next Therapist appointment and we talked to him and asked him to help. And, he has, but I got even more help from my psychiatrist today. I told him about the compulsive shopping and he immediately focused on dopamine agonists. It was first prescribed at the end of February 2016 for Restless Legs Syndrome (RLS.)

It has been discovered to have a very nasty side effect. It increases and causes compulsive activities.

Dopamine agonists were first released to the public in 1997. An ABC News article titled Strange Side Effects Surprise Patients, published July 15, 2008, stated the following:

Dopamine agonists, which mimic the brain chemical known as dopamine.

Dopamine works in the brain's movement and coordination centers, and it is also involved in the brain's pleasure response by reinforcing behaviors that provide enjoyment -- including drinking, drugs, sex and gambling.

The article went on to say that the makers of these dopamine agonists have been putting warnings in their medication documentation, but did not realize that it had gotten this out of hand, as stated in the ABC News article:

Scientists have recently begun to quantify the behavioral changes associated with dopamine agonist drugs. In a study presented in late June at the International Congress of Parkinson's Disease and Movement Disorders conference in Chicago, more than 13 percent of 3,090 Parkinson's patients had a problem with compulsive gambling, buying, sex or binge-eating.

People who were taking dopamine agonists had a two- to three-times greater chance of having one of the four impulse-control disorders.

A two to three chance? How about those who already have compulsive disorders? I can attest the chance of affliction is much higher and the effects are so much stronger.

What are dopamine agonists? 

According to the Parkinson's Disease Clinic and Research Center:

There are two commonly prescribed oral dopamine agonists in the United States:

Pramipexole

Ropinirole

• Apomorphine, a subcutaneously administered dopamine agonist, was approved for use in the United States in 2004. The dopamine agonists differ in several respects, including
• chemical structure
• duration of action
• side effects
• 
  
• Bromocriptine and the recently withdrawn pergolide are ergot derivatives and may rarely cause retroperitoneal, pulmonary, and pericardial fibrosis, and cardiac valvulopathies. Pramipexole and ropinirole have half-lives 6-12 hours and are therefore taken 2-3 times daily.
•  
• Pramipexole and ropinirole 
• Pramipexole and ropinirole are not ergot compounds. Large clinical trials comparing these medications to levodopa showed that they can be used in early Parkinson's disease and reduce the severity of symptoms. Over the years, differences in the effects of the dopamine agonists have emerged. One side effect is daytime sleepiness and "sleep attacks." Although this may occur with all of the dopamine agonists (and levodopa), it was first appreciated in people treated with pramipexole.
• 
  
• Apomorphine 
• Apomorphineis indicated in patients who experience "off states"refractory to modifications of oral medications such as increasing the dose or frequency of dopaminergic medications or introducting a COMT inhibitor. It has a rapid onset of action, usually within 10-20 minutes but the duration of action is short, lasting for only about an hour. Apomorphine is only available from specialty pharmacies. Because nausea occurs in the vast majority of patients, pretreatment with trimethobenzamide (Tygan®) is required. Initial titration and observation for side effects (syncope, hypotension) must occur in the physician's office.

In January 2014, the Addiction.com website wrote an article that provides some helpful information about what to do if you’ve been taking dopamine agonists.

If you’re a patient taking a dopamine agonist, the options are unfortunately limited. It’s worth noting that the incidence of these side effects is quite low, but there is still a chance you’ll develop them. If you’re experiencing symptoms of compulsive behavior after starting on a dopamine agonist, the best thing to do is to contact your doctor about it as soon as possible. Compulsive gambling, sex and shopping all have the potential to financially ruin patients or obliterate romantic relationships, so the importance of reducing their impact can’t be overstated. In the event of negative consequences, your physician may be able to suggest an alternative treatment. Do what you can to better your health!

As for my mental health, my psychiatrist took me off the medication immediately. I am now taking supplements to treat my Restless Leg Syndrome (RLS): Potassium and Magnesium. It will take approximately two weeks for the effects of the drug to leave my system.

I no longer have this dark cloud hovering over me, questioning every purchase or thought of purchase. I have a better future to look forward to with my husband and our plan to get out of debt.

Have a blessed and happy day.

Vicki