If the Shoe Fits… Impulse Control and Pramipexole

Once upon a time, I bought a pair of shoes.

I bought a pair of shoes at 3 AM and when they arrived, I didn’t remember buying them.

At the time of this unfortunate shoe-purchasing incident, I’d been taking pramipexole for around 5 years. I’d had no side effects and had yet to experience any augmentation (that would come later).

Pramipexole seemed like a miracle cure for my out-of-control restless legs syndrome. I went from being on the verge of psychosis, due to being awake and twitchy almost 24/7, to feeling peaceful and rested. Words alone cannot articulate the bliss a restless legger feels when stillness descends.

So, imagine my distress when it gradually dawned on me I’d become one of the 17 to 25 percent of people who developed impulsive-compulsive spectrum disorders as a result of taking the medication.¹

What is pramipexole?

Pramipexole is a dopamine agonist used primarily in the treatment of Parkinson’s disease (PD) and restless legs syndrome (RLS) to increase dopamine production and reduce motor control symptoms.

Dosages for PD tend to be a lot higher than the recommended treatment for RLS, so accompanying side effects may be more severe for those suffering from Parkinson’s disease, but can still be problematic for those of us with restless legs.

Dopamine and the pleasure-reward response

Dopamine is a neurotransmitter known to be in short supply in PD and RLS. It is also released when we experience pleasure and is sometimes known as the sex, drugs and rock ‘n roll neurotransmitter. By increasing dopamine, we can enhance the pleasure-reward response, and this can – in some people – lead to increased impulsive and/or compulsive behaviours associated with gambling, shopping, eating, substance abuse, or sex.

My impulse control issues developed over time

The trouble with developing impulse control issues is they tend not to be abrupt. It is a slow evolution and can take quite some time before it becomes clear there is a problem. So it was with me.

I have always had a natural tendency to be a little bit impulsive and compulsive. I like to think of it as spontaneous and devoted, but like many things in life, you can have too much of a good thing.

I did not notice what was happening

As time wore on, my dose of pramipexole increased and my impulse control decreased. I didn’t notice, though. I just thought I was feeling happy (from all that blessed rest) and engaging in self-soothing strategies by treating myself to a little bit of this – and a lot of that. I felt pretty good, in all honesty.

One day my husband sent me an article he’d stumbled across on the internet. It was the story of a woman whose life had been ruined when she developed a gambling addiction after commencing pramipexole. She lost her home. Her family. Her self-respect. She lost everything.

A frank discussion with my doctor

While it is important not to believe everything you read on the internet, it can be a good starting point for a frank discussion with your doctor. Which is what I did. At my next appointment, I mentioned my increasing tendency to purchase things I both did not need and could not afford.

We talked about the potential side effects – weighing up the pros and cons of being on the medication versus having completely untreated RLS. After monitoring my impulses and behaviours for a few months, I decided to modify my dose rather than go off it completely.

The importance of self-awareness

Reducing the pramipexole meant a small increase in my RLS symptoms but a big decrease in my addictive behaviours. It is not always easy to tell the difference between natural tendencies and drug side effects – it is easy to blame one or the other – but I found a balance that works for me.

I was also more aware of what was going on, and that in itself helped me to control impulsive behaviour. I found I didn’t need to go all or nothing with my medication.

Maintaining balance

Fifteen years later, I am still taking pramipexole – at the lowest available dose. I am aware of potential side effects and pay attention if my credit card starts flashing out of my wallet too often. While surprise shoe purchases can feel fun in the moment, the potential consequences can be very damaging.

With awareness and good medical support, I have found the best of both worlds – blessed relief for my restless legs and just the occasional spontaneous purchase of kick-ass shoes.