Hypersexuality and Neurological Disease

Jessica Wurtz's picture

      The word nymphomania is often used in an almost slang sense in modern language, especially in the abbreviated form of “nympho”.  While it is often used loosely, it is important to remember that there is a clinical basis for the word, although the disorder is more commonly called hypersexuality, perhaps to move away from the connotations that are now attached to the word nymphomaniac.  Upon researching hypersexuality, many articles came up that related various drug therapies in relation to hypersexuality, the most common one was any drug therapy related to Parkinson’s disease.  There were also articles about hypersexuality and drug therapy for strokes and epilepsy.  I found this to be quite interesting due to the fact that one does not often associate hypersexuality with older people, who are much more likely to have developed Parkinson’s disease or have had a stroke.  To discover how the two were related, research had to be done to discover what the effects of these diseases and their drug therapies had on the brain.

      Parkinson’s disease is a disease that affects the central nervous system and impairs the patient’s motor skills as well as speech.  The disease is thought to be caused by a decrease in stimulation of the motor cortex by the basal ganglia, which is caused by insufficient amounts of dopamine.  Parkinson’s is chronic and progressive and there is currently no cure, but drugs are used to relieve symptoms and slow the progression (1).  The drugs that are used are L-dopa drugs, dopamine agonists, and MAO-B inhibitors.  All of these drugs have an effect on dopamine in the brain, whether it is a transformation of the drug directly into dopamine, stimulation of dopamine receptors, or the prevention of the breakdown of dopamine (1).

      There are several documented cases of Parkinson’s disease patients experiencing hypersexuality due to their drug therapies for their disease symptoms.  A study at the Mayo Clinic showed that thirteen Parkinson’s patients experienced hypersexuality.  This study attributed the problem to an inhibition of prolactin secretion (2).  Prolactin is a hormone that plays a part in regulating the levels of sex hormones, and it also represses the effect of dopamine.  It can also be indicative of the level of sexual satisfaction a person is feeling; high levels of prolactin are usually associated with impotence and a loss of libido as well as a decrease in sex hormone (3).  So if a patient was on drugs that inhibited the release of prolactin, the low levels might have the opposite effect and increase a person’s libido.  Another study looked at a patient who was taking L-dopa and a dopamine agonist called bromocriptine (4).  This patient’s dosage of these drugs might have been too much, causing too large of an increase in dopamine, causing their hypersexuality.  In a third example of a Parkinson’s patient and hypersexuality, a man with Parkinson’s developed delusional jealousy and frotteurism, which is a disorder where the person rubs against or touches another person in order to achieve sexual arousal or orgasm (5).  This patient was on pergolide, which is another dopamine agonist that stimulates dopamine receptors (1). Upon decreasing the dose of pergolide in combination with taking quetiapine, an atypical neuroleptic drug that is responsible for antagonist activity on dopamine and serotonin receptors, which allows normal levels of dopamine to be released, the patient’s behavior returned to a normal level (5).

      There were two different articles that mentioned strokes in relation to hypersexuality.  In one case, a man developed a psychotic disorder with delusions due to a stroke, and also developed hypersexuality and delusional jealousy.  The man was given quetiapine, like the patient with Parkinson’s previously discussed above.  After only two days on the dose of quetiapine, the man showed a significant difference in his hypersexual behavior (6).  In another case of strokes in relation to hypersexuality, stroke patients with lesions on their temporal lobes due to the stroke developed hypersexual behavior, but it was not said if they were given medication to remedy the situation.  The article also mentioned that animals that had temporal seizures also demonstrated hypersexuality (7).

      The epilepsy patients discussed had temporal lobe epilepsy, so they also had damage to their temporal lobes like the stroke patients.  In the cases of the epilepsy patients, both patients were taking the drug Lamotrigine, or LTG.  LTG is an anticonvulsant that reduces epileptic seizures by decreasing the levels of glutamate (8).  Glutamate is the most abundant fast excitatory neurotransmitter and is implicated in epileptic seizures because in experiments, the injection of glutamate into neurons causes depolarizations, which can cause voltage activated calcium channels to open, causing the release of more glutamate and more depolarizations.  These depolarizations look very similar to paroxysmal depolarizing shifts in epileptic attacks (9).  In the cases of the epilepsy patients, the LTG had the same effect on both but to a different degree.  In the first patient, the LTG caused intense sexual desires that were uncomfortable and unpleasant for the patient.  The patient’s dosage was decreased until his level of sexual desires returned to the levels previous to taking LTG.  In the second patient, the LTG also increased his sex drive, but not to the point of discomfort, instead the patient enjoyed this newfound revival of his sex life (8).  Another article mentioned that several temporal lobe epilepsy patients experienced hypersexuality after having a temporal lobe resection operation (10).

      After looking at all of these examples of patient’s with hypersexuality due to other medical causes, it seems that the levels of dopamine play the most important role for many.  This makes sense as dopamine is associated with the pleasure system of the brain, and dopamine is released during sexual activity.  As for the patients with damage to the temporal lobe, mesolimbic dopamine is associated with creativity in the frontal and temporal lobes, but it is unclear how this is related to hypersexuality exactly (11).  This is a good example of how much of our behavior is out of our actual control.  This is especially evident in the epilepsy patient who was extremely uncomfortable with his new sex drive and sexual desires, but could not change the way he was behaving due to the chemical imbalance in his brain.  I feel this is also a lesson in taking care what drugs should be given and how much in order to produce the optimal effect without inducing other unwanted problems for a patient.

WWW Sources

1) http://en.wikipedia.org/wiki/Parkinsons_disease, definition page, Wikipedia

2)http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2575449&dopt=Citation, article abstract, PubMed

3) http://en.wikipedia.org/wiki/Prolactin, definition page, Wikipedia

4)http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6685318&dopt=Citation, article abstract, PubMed

5) Cannas,-Antonino; Solla,-Paolo; Floris,-Gianluca; Tacconi,-Paolo; Loi,-Daniela; Marcia,-Emanuele; Marrosu,-Maria-Giovanna. “Hypersexual behaviour, frotteurism and delusional jealousy in a young parkinsonian patient during dopaminergic therapy with pergolide: A rare case of iatrogenic paraphilia.” Progress-in-Neuro-Psychopharmacology-and-Biological-Psychiatry. Vol 30(8) Dec 2006, 1539-1541., article, through Psycinfo

6) Chae,-Beang-Jin; Kang,-Byung-Jo. “Quetiapine for hypersexuality and delusional jealousy after stroke.” Journal-of-Clinical-Psychopharmacology. Vol 26(3) Jun 2006, 331-332., article, through Psycinfo

7)http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3718200&dopt=Citation, article abstract, PubMed

8)http://sfx.exlibrisgroup.com:9003/brynm?sid=SP:PSYI&id=pmid:&id=doi%3a10.1016%2fj.yebeh.2006.01.005&issn=1525-5050&isbn=&volume=8&issue=3&spage=663 &pages=663-665&date=2006&title=Epilepsy%20and%20Behavior&atitle= Hypersexuality%20in%20two%20patients%20with%20epilepsy%20treated%20with%20lamotrigine.&aulast=Grabowska-Grzyb&pid=%3Cauthor%3EGrabowska%20 Grzyb%2c%20Albena%3bNaganska%2c%20Ewa%3bWolanczyk%2c%20Tomasz%3C%2Fauthor%3E%3CAN%3E2006-05826-033%3C%2FAN%3E%3CDT%3E Journal%3bPeer%20Reviewed%20Journal%3bOriginal%20Journal%20Article%3C%2FDT%3E, article, through Psycinfo

9) http://en.wikipedia.org/wiki/Glutamate, definition page, Wikipedia

10)http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=12609419, article abstract, PubMed

11) http://en.wikipedia.org/wiki/Dopamine, definition page, Wikipedia

Comments

Serendip Visitor's picture

epilepsy and sexualty

This makes me wonder is my epilepsy had anything to do with my development of an obsessive diaper fetish. I have a brain injury and epilepsy when I was under 10 and when I hit puberty a very strong diaper fetish hit me and never left even decades later.

Frances Irons's picture

Hypersexuality in Parkinson's Disease

Need information from Duke University regarding latest treatment and/or surgery for Parkinson's Disease.
My son has had Parkinson's for many years and has DBS implanted...He is now 64 years of age and contracted the disease in
his 30's. Of special interest is hypersexxuality complications.

ironjustice's picture

Parkinsons Treatment

One could look at this in the perspective of 'cup half full' and see WHY they ARE 'now' showing these problems.
WHAT is common amongst the OTHER seemingly NOW **associated** problems such as smoking and drinking ADHD and such ..
The cholinergenic pathway is being targeted in that the nicotine in the cigarette .. enjoyed .. BY those that have Parkinson's and those that enjoy gambling and carrying on AND hypersexuality.
The use of choline is evidenced by the efficacy of drugs which are used in Parkinson's and Alzheimers which are targeting the cholinergenic pathways ALSO influenced by nicotine.
If one looks at the effects of iron in the brain and the results of TARGETING this iron.
"Her gait returned to normal"

One can NOW see what iron does to the dopamine in the brain.
This is evidenced by the Parkinson's which evolves FROM the spillage of iron into the brain due to boxing or other head induced trauma blood spillage.

"Her gait returned to normal"
"Iron chelating treatment"

http://www.ncbi.nlm.nih.gov/pubmed/18383118

Believe it or .. not ..

nympho's picture

Nice article from NYtimes

A good article about hyper sexuality and Parkinson disease has been written on the Times.

Parkinson's disease (PD) is not fatal, but it can reduce longevity. The disease progresses more quickly in older patients, and may lead to severe incapacity within 10 - 20 years. Older patients also tend to have freezing and greater declines in mental function and daily functioning than younger people. If PD starts without signs of tremor, it is likely to be more severe than if tremor had been present. Having other family members with PD does not appear to have any effect on the severity of the disease.

Parkinson's disease can seriously impair the quality of life in any age group. The physical and emotional impact on the family should not be underestimated as the patient becomes increasingly dependent on their support.

Treatment advances are increasingly effective in alleviating symptoms and even slowing progression of the disease. Taking many of the medications over time, however, can produce significant side effects. Newer drugs may help reduce these occurrences.

source: http://health.nytimes.com/health/guides/disease/parkinsons-disease/complications.html

Anonymous's picture

a good paper by the college student

This was a good paper by the college student. A few years ago I started taking Wellbutrin XL for depression (manic depression or bipolar disorder.) As Celexa SSRI wasn't doing much quite honestly. Many people with bipolar can't take Wellbutrin as it makes them hypomanic or fully manic. For me not so -- regarding depression it is a wonder drug for me. But since it does elevate dopamine level, hypersexuality is stronger now than it was before. I am willing to have this side effect in exchange for the benefit of fixing the depression. But hypersexuality is a bit weird. It isn't just the "release" of dopamine during sex as the student suggest I can tell first hand. The dopamine is there to begin with -- which is the purpose of the student's topic after all. It is the cause of the sexual need, not the result of taking care of the sexual need. The trouble is the need arises virtually each day, and if you are not in a relationship that involves a lot of sex, such as in my case currently with my relationship with my wife faltering due to a variety of reasons, you obsess too much with women you encounter who are sexy, and you may have a desire to look at soft or hard porn and relieve yourself. So it is a problem. It may not be all cases of sex addiction, but it certainly is at least a subset of sex addiction -- all hypersexual people are addicted technically because of the need for sex that goes beyond normal, meaning a high need to empty the prostate I believe. Perhaps dopamine is concentrated in the prostate and emptied upon sex -- or increased dopamine increases some hormone such as testosterone which is concentrated in the prostate? It feels that way anyways. I think a mistress would solve my problem. But I have not cheated on my wife (yet anyways.) This is why hypomanics are viewed to be "womanizers" (or manizers for females) -- it is hard to believe, but they really do have a brain chemistry reason for their wanderlust. I am guessing Bill Clinton fits into this category. If you don't walk the person's shoes, you have no way of telling what it's like to be hypersexual. I suppose if I took an SSRI in addition to Wellbutrin, the two might counter each other out. I may try that some day, or I may try Cymbalta which I think works on dopamine and serotonin, while Wellbutrin works on dopamine and norapenephrine, as I think serotonin decreases sex drive.

Anonymous's picture

The funny thing about this

The funny thing about this is as a toddler I was fondled with, as teen I was sexually abused and there is a dent in my head where no one could see, my mother told me that when I was baby there was a soft patch filled with liquid in my head where that dent lays she seems to think that the place where I was born were doing experiments. I know for a fact that I do have a chemical imbalance but whether the hospital caused it idk. At the same time where does my psychological disadvantage play a part. All I know is that I want to love myself and I can't because sex is in the way.

Dr Swaroop R's picture

Oh ... my sympathies with you

I read your story and I am really sad over the way things went for you. Its a horrible feeling to be punished for no mistake of your own. I totally understand your situation.

I'm a 24 year old doctor. I was supposed to be doing a higher specialisation. But am at home because of 'health issues'. It was like this, ... I had excessive fatigue and sleepiness and depression and for that, my psychiatrist gave me modafinil 100mg bd.

It worked wonderfully, I was starting to feel that my problems were going to end soon. But in a week, I was being accused by people of being too cocky and aggressive. A lot of people sent me messages saying, " i never expected this from you, I am totally shocked, I hope we never cross paths again"... Even my brother attacked me once when I impulsively scolded him once...

Except for a couple of understanding people, everyone has left my life..

Its really hard I understand... that too things like these are not addressed in medical books and journals as much as we would like it to be.

Sorry there friend,
please keep your head high,
there is absolutely no mistake on your part...
no need to be upset about yourself at all.
it was all unintentional on part of the neurologist too, so no point in holding him either

just that the world is a rotten place... sorry if i made a generalisation... but i am true...

Cabergoline's picture

Cabergoline

I have early-onset Parkinson's. I've been showing showing symptoms since I was 25 and diagnosed at 30. My two older brothers also were diagnosed with Parkinson's. I'm 44 now. I have a doctorate in linguistics and work with cognitive scientists. Believe me, I'm not naive about neurological pathologies.

Well, a little pill can be a very dangerous thing if left unchecked. I've been on agonists for some six years now and my "drug of choice" is cabergoline (commercially known as: Dostinex, Sogilen, etc.). It helped my movement problems quite a bit, but it's probably destroyed my marriage.

My wife started complaining some years ago that I was asking for too much sex. She also complained that I took too long to reach a climax. Being the compulsive one, I didn't see it that way: I thought I was relatively normal. I didn't get it.

I went through several years of denial. Finally, about a year or so ago, I did some research myself: I easily turned up information about the association between agonists and hypersexuality. I also noticed that cabergoline was being sold as a Viagra alternative on the Internet. I told my wife that this was the problem. Of course, now I had to work up the nerve to tell my neurologist. The problem is embarrassing, to say the least.

After a disastrous attempt to change to rigotine transdermal patch, my neurologists decided to go back to cabergoline at a lower dosage and to supplement it with Sinemet Plus.

Two weeks ago, my wife asked for a separation. Think about it: hypersexuality leads to rejection and rejection leads to anger. And anger can only lead to more anger, not understanding. Parkinson's individuals lead lives of permanent discomfort, bouts of depression, lack of motivation, among many other problems. We desperately need all the understanding we can get.

My wife says she understands that the problem of hypersexuality has been caused by the agonist, but she is not sure she can get over the hurt. She feels that I have used her for sex. She says she cannot rationalize her emotions.

I went to my neurologist without an appointment, fought past the insolence of the gatekeeping secretaries, and came clean. The neurologist immediately weened me off the agonist. What good is a medication that ruins the rest of your life? None whatsoever.

Neurologists need to understand that, when they prescribe an agonist, they need to check with the spouse or partner about the patient's behavior. Given the very nature of compulsive behaviors, the patient, however unnaive he or she may be, is not the right person to ask.

pissed off's picture

bromocriptine

I have only this week just relised a side effect to the drug BROMOCRIPTINE for which I have taken for 16 years.All this time I have thought what is..HYPERSEXUALITY..to be a bad habbit and nothing more.Now I realise HYPERSEXUALITY is a side effect.This has had a massive influence on my life.All this time I have carried the guilt with me thinking it was a bad habbit.My doctors/specialists have kept me in the dark about this also, I assume.WHAT A FUCKING JOKE! As a 36 yr old,this drug I now realise has had just as much bad effect on me as good.I am lucky to be alive.I can not believe how risky some of my behaviour has been because of the side effect to this pethetic drug.I only now start to wonder how all this HYPERSEXUALITY has affected my life.I have been suffering major depression on and off for 10 years.This has all been to much for me to accept ...............

Anonymous's picture

Glutamate & TLE & Sex drive

I was treated once with Dilantin for TLE.
But my question is about the glutamate. RE: "Glutamate is the most abundant fast excitatory neurotransmitter and is implicated in epileptic seizures because in experiments," etc.

I am unable to take the over the counter form of Glucosamine because it has the same effect on me that was described in above article. It gives me intense sexual desire and I agree it is not a pleasant thing, I can't sleep, there is no way for me to satisfy it so I don't even try, it is beyond normal drive. It's a shame too because it was helping my neck pain a lot but it's just not worth it. Sounds hard to believe that a strong sex drive could be a bad thing but it is, especially for a woman, a christian woman.

Could the Glucosamine also lead to other TLE moments? Is Glucosamine related much to Glutamate?

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