Dopamine and gambling?

An article in The Economist refers to a recent Archives of Neurology article indicating that some patients given dopamine agonists may develop compulsive gambling, or other compulsive behaviors.

Seems a little hard to believe, in the sense that it would seem that this couldn't be such a "secret" from us practicing neurologists. Why haven't I seen something like this? Seems like it's got to be quite uncommon/rare.

I'll have to check the original article and update this issue.

Addendum:

In many ways, an unfortunate article (currently published only online). The title of the article, Pathological Gambling Caused by Drugs Used to Treat Parkinson Disease, right off the bat, is misleading. The implication is that it is obvious that the drugs caused the compulsive gambling.

Since no information is given about the drugs (mostly pramipexole, but also ropinirole in a couple) causing compulsive gambling in anyone without Parkinson's disease, the first question is whether the drugs or the Parkinson's were the essential causative agent. A better title might have been, "Pathological Gambling Triggered by Drugs Used to Treat Parkinson's Disease in Patients with Parkinson's Disease." This is important, since these medicines are now used, some say as preferred agents, for things such as restless legs syndrome. Are these people at risk of compulsive gambling?

Based on the information given, it makes more sense that there is some kind of substrate of behavior in patients with Parkinson's which can lead to behavioral problems with these drugs. In our highly litigious society, the article as written now will open up lawsuits against neurologists prescribing these drugs for whatever reason, wanting compensation for gambling losses (Lawyer logic: gambling losses + pramipexol = $$$$). Since one of the patients mentioned incurred gambling debts in excess of $100 000, this is not a minor issue. So, who should pay, the neurologist or the drug company? Trial lawyers will suggest both.

Some additional information gaps in this article:

1. We see a report of the number of patients cited (11), but what is the denominator? There is no estimate of the risk, other than the abstract saying, "rare." 1:100, 1:1000, 1:10,000?


2. There is no mention of MRI or other testing done to look for underlying substrate in the brains of these patients. Presumably there is some kind of anatomical reason why these few people developed the problem.


3. Is there a reason to now be cautious with the use of these drugs for other disorders, such as restless legs syndrome? If not, why not?

So, in many ways, this article raises many scientific questions which it does not answer, and in the process creates societal and legal issues.

This is not quality medical publishing.