In a recent episode of The Global Story, the BBC raised an issue that has been debated for years in the medical community. Drugs from the class of dopamine agonists, widely used in neurology and psychiatry, can trigger compulsive gambling and other forms of self-destructive behaviour. BBC correspondent Noel Titheridge, who spent years collecting patients’ accounts, presented a report in which dozens of people say the same thing: they were not adequately warned about the risks.
How dopamine agonists work
Dopamine agonists are a class of medications made by several pharmaceutical companies. Their mechanism of action is based on mimicking dopamine, one of the brain’s key neurotransmitters. The drugs activate dopamine receptors, helping to compensate for a deficit of this substance in the body.
Their main use is in Parkinson’s disease. For many patients with this diagnosis, dopamine agonists remain, in Titheridge’s words, “life-changing” medications, which explains their continued demand on the market.
In addition to neurology, such drugs are sometimes prescribed to people with recurrent depression. It was in this context that some of the stories collected by the BBC journalist emerged.
The side effects being discussed
The BBC report describes a characteristic set of impulsive and self-destructive manifestations that patients encountered:
• hypersexuality;
• compulsive gambling with major financial losses;
• uncontrolled spending and compulsive shopping;
• aggressive, risky driving;
• other impulsive behaviours that were out of character before treatment began.
All these side effects are not just unpleasant—they can significantly damage a person’s life. For example, a tendency toward compulsive gambling today can even lead to bankruptcy due to the high level of accessibility of gambling.
The accessibility of entertainment in the iGaming industry worries many experts. And not only in the West but also in developing countries in Asia or South America. The market is growing most actively in the largest countries in Africa. According to data from the online-casino website No Deposit Bonuses Nigeria, in the past year alone the number of bonus offers has grown by a third. And the number of platforms that offer bonuses has increased by nearly 20%.
Online casinos operate 24/7. And to start playing, you don’t even have to go anywhere. It is enough to pick up your phone or sit down at a computer to gain access within seconds to thousands of different forms of entertainment—from slots to sports betting.
It’s easy to imagine what this level of access can do to the finances of a person prone to compulsive gambling. For now, the question of pharmaceutical companies’ responsibility in this situation remains an open question.
The scale of the testimonies and a common theme
Titheridge said that during the investigation he contacted around 350 people who had experienced similar side effects. The most common refrain in their stories came down to one thing: no one explained how serious the consequences of taking the drugs could be.
The French patient who prompted the investigation
One of the first stories to draw Titheridge’s attention was the case of a man from France. After being prescribed dopamine agonists, he developed hypersexuality and a compulsive urge to gamble. Personal relationships were destroyed, and the financial losses were significant. The man filed a lawsuit against the pharmaceutical company, arguing that he had not been warned about the risks.
Charlene from Massachusetts and the gradual escalation of symptoms
A 52-year-old resident of Massachusetts named Charlene began taking dopamine agonists in 2016 for recurrent depression. In the first months, she did not notice anything unusual. According to Titheridge, such a “subtle” start is typical.
A few months later, Charlene felt what she herself called an “insatiable sexual desire,” began seeking casual encounters, started driving more aggressively, and spending money uncontrollably. When the money ran out, she resorted to shoplifting. That was what made the woman realize that something abnormal was happening to her.
Charlene consulted a psychiatrist and stopped taking the medication. However, the actions she committed under the influence of the drug continued to haunt her emotionally.
Scientific estimates of the frequency of side effects
In the early 2000s, researchers concluded that about one in six patients taking dopamine agonists experiences the side effects described. A number of other academics gave a higher estimate: as many as one in three. The wide range of estimates suggests that the issue has not been fully studied.
Why awareness lagged
Dopamine agonists were long seen as a breakthrough in the treatment of Parkinson’s disease because they did not have the side effects associated with earlier treatments. This, in Titheridge’s view, led to insufficient study of the risks at an early stage.
Over time, warnings did appear in the patient information leaflets for the drugs. However, patients interviewed by the journalist indicated that the wording was vague, and doctors often brushed off complaints. Against this backdrop, individual lawsuits alleging clinical negligence were filed. Pharmaceutical companies, for their part, insist that information about the risks is set out clearly enough. A proposal to introduce US labelling at the level of a “black box warning,” similar to the warnings on cigarette packs, was discussed but ultimately rejected.
Balancing benefits and awareness
The discussion today focuses on the quality of communication between doctor and patient: how clearly and in a timely manner people receive information about the possible consequences of therapy. At the same time, for a significant proportion of patients with Parkinson’s disease, dopamine agonists remain an indispensable element of treatment, and a complete withdrawal from them is not being considered.