Betting on Dopamine
Her Parkinson's symptoms initially worsened but improved in response to adjuvant low-dose levodopa/carbidopa treatment, and her interest in gambling decreased.
Abstract
CASE STUDY Betty is a 59-year-old woman who has suffered from Parkinson's disease for several years. Various treatments were tried, and a combination of pergolide (a dopamine agonist) and selegeline (a monoamine oxidase type B inhibitor) was eventually settled on with reasonable results. There was no history of other medical or psychiatric symptoms and she was able to maintain a good quality of life. However, after several months, Betty reported that she was spending a good deal of time on scratch lottery cards and slot machines and had placed several hundred dollars worth of bets. She had long had some interest in these kinds of activities, but she was not well-off and had previously limited her betting to only a few dollars. She indicated that she often felt on edge and that betting helped her relax. On examination, although there was some pressure of speech and flight of ideas, she did not meet diagnostic criteria for a bipolar II disorder. Her physician was reluctant to change her Parkinson's disease medications. Instead, the physician prescribed a low dose of risperidone (0.5 mg/day, increasing to 1 mg/day). She subsequently reported less interest in gambling. Her Parkinson's symptoms initially worsened but improved in response to adjuvant low-dose levodopa/carbidopa treatment.