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Noel Titheridge
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Asma Khalid
hey there, I'm Asma Khalid.
Noel Titheridge
And I'm Tristan Redman, and we're here with a bonus episode for you from the Global Story podcast.
Asma Khalid
The world order is shifting. Old alliances are fraying and new ones are emerging. Some of this turbulence can be traced to decisions made in the United States. But the US Isn't just a cause of the upheaval. Its politics are also a symptom of it.
Noel Titheridge
Every day we focus on one story looking at how America and the world shape each other.
Asma Khalid
So we hope you enjoy this episode and to find more of our show, just search for the Global Story wherever you get your BBC podcasts. Today we've got a special BBC investigation for you all. It's a really, really fascinating story, but I also want to note that this episode talks about sex and there's a mention of suicide. So. So please take care while listening. And if you have little ones around, you might wanna listen to this at a different moment. When Charlene was 42 years old, living in Massachusetts, she began taking this new medicine to help her with mild depression. The drug worked. Her mood improved. But after taking it for a while, her behavior also started to change dramatically.
Charlene
I had this kind of insatiable sex drive all of a sudden, and that meant seeking out men wherever I Could seek them out.
Asma Khalid
What Charlene didn't realize because the thought never crossed her mind, Was that these changes were a side effect of her new medication. Millions of people all over the world have been prescribed drugs like the one Charlene was taking. They're called dopamine agonists, and they're used to treat various illnesses, From Parkinson's to depression. But for an alarming number of patients, these drugs don't just treat the symptoms of those diseases. They also have side effects that can fundamentally alter people's personalities. I'm Asma Khalid. And today on the global story, A new BBC investigation has heard from hundreds of people whose lives were turned upside down by prescription medications. How did this happen? And why do patients say they weren't so sufficiently warned? Well, Noel, it's a pleasure to meet you. Thanks for coming on the show.
Noel Titheridge
Thanks for having me.
Asma Khalid
Noel titheridge is an investigations correspondent at the BBC, and he's been working on this investigation for over a year. I kicked off our conversation by asking him how he first came across this story.
Noel Titheridge
Well, I heard about a case going through the courts in France, so that involved a French man who's suing a pharmaceutical company, saying that they didn't properly warn him about side effects of the medications he was on. He says that he developed compulsive sexual urges, what's known as hypersexuality that ruined his relationship. He also said that he had lost more than $100,000 to compulsive gambling. I'd never heard about this before, and I couldn't believe that prescription medications could be that powerful. So I wanted to know how widely are these drugs used and how common are these side effects?
Asma Khalid
Okay. And I know your reporting specifically looks at this class of drugs, dopamine agonists. Can you walk us through what these drugs are used for? What do they do? What do they do to our brains?
Noel Titheridge
Yeah. Well, they're a family of drugs. They were developed and manufactured by multiple companies. These drugs are widely used for Parkinson's and then other conditions like restless leg syndrome and even, in some cases, depression. Now, the way they work is they boost dopamine activity in the brain. So dopamine's this chemical that's vital in coordinating our smooth movements. So the drugs can be really effective for Parkinson's sufferers that suffer from shakes and tremors. But we also know dopamine is that key chemical in. In driving feelings of motivation and reward. You know, the idea of the dopamine hit, this need for instant gratification, and it's thought that these drugs can overstimulate these feelings of motivation and reward.
Asma Khalid
So just to be clear, you've been investigating this, Noel, for, is it more than a year now, and spoken to hundreds of people, you say, who took these medications who had very similar problematic side effects?
Noel Titheridge
Yeah, that's right. You know, over 350 people in all have been in touch with us. Many of them talk about ruinous sexual urges, about compulsive gambling that cost them tens, hundreds of thousands of dollars. And what's really striking is that many of them say that they weren't properly warned about these side effects. And this has had devastating consequences.
Asma Khalid
So, as you say, you have spoken to hundreds of people and, and I know you've done some original reporting for us here at the Global Story. You spoke with a woman by the name of Charlene who lives in the U.S. can you tell us a little bit about her?
Noel Titheridge
Yeah. So Charlene's 52, she's from Massachusetts.
Charlene
At the time, it was 2016, and I was seeing a psychiatrist for depression. I'd had depression on and off since I was a teenager. I was functioning, though. I had a career, had a master's degree, was doing well, had a partner. So life was going pretty well. It was just these symptoms that I wanted to see if we could control better.
Noel Titheridge
So she was already on an antidepressant drug, but her psychiatrist prescribed her another drug from this family that we're interested in called dopamine agonists. And it was this drug she was prescribed alongside her antidepressant.
Asma Khalid
So Charlene starts taking one of those dopamine agonists. And what happens after she starts taking that medication?
Noel Titheridge
Well, for the first couple of months, nothing. And that's actually common to lots of people that have contacted us. It's not like these side effects immediately emerge and that often makes it hard to spot them when they do emerge. Now, Charlene works with blind people. That was her job. She helps them, teaches them navigational aids, things like canes and guide dogs. And it was while working with a client that she'd already known for some time that her new behavior began to emerge.
Charlene
I was working with this client who was very flirtatious with me. So I would tell my colleagues, oh, he's very flirtatious with me. But never in my mind would I have thought, I'm gonna have a relationship with this person. Ethically, it wasn't something I would do. But then one day, something changed. All of a sudden, I was very bold and went up to him and just said, why don't you just kiss me? And he did. That launched me into so much more danger. From that point on, I should provide a little bit of context. Imagine you're a person who's had this kind of depressive state for your life, and then suddenly this dopamine is in your brain and it's pushing it to the highest level that it can get. It feels pretty good. You think your depression has been cured and it feels like you're living your best life. And part of living my best life was, well, I had this kind of insatiable sex drive all of a sudden. And that meant seeking out men wherever I could seek them out. I would go to bars and get all dressed up and just pick somebody up at the bar. It can be anybody on the street. I've went into the local pizza place and found a guy. The local 711 found a guy. I needed to have sex with as many people as I could have sex with. That's what it felt like. Like there was this drive that you had to do this.
Noel Titheridge
So for Charlene, this had consequences. She'd been in a stable relationship for six years. She confessed to her partner that she'd been sleeping with other men and he ended the relationship. But crucially, he would have had no idea that her new impulsive behavior could be attribut to the medication that she's on. But after the relationship, the consequences begin to get even more serious that some of these sexual encounters that she described involved significant physical abuse.
Charlene
So that one summer of 20, it was 2017, I had estimated I had sex with about 25 different men and they would bring a friend the next time and it would be a threesome and then a foursome. And then I think it got up to one time, five, five different men. It ended up turning into some very unsavory characters. And so when you think about how that feels in the moment, it felt good. It felt like I was really elated doing that, that, that satisfied that need. But then after you. You realize, why am I having sex with five, five men? But it doesn't occur to you that something's wrong, Something's wrong with you due to the medicine. It's just you kind of think, well, I'm 42 or 43. Maybe this is what it's like to not be depressed. Maybe this is what it's like to be perimenopausal. And there was no kind of thinking at that time that something was really wrong.
Asma Khalid
Gosh, Noel, this sounds really, really awful. And it sounds like she also doesn't know why these things are happening to her. Were the behavior changes that Charlene exhibited Largely sexual behavior changes? Did she experience other types of compulsive behavior?
Noel Titheridge
She did. Many of the people that have contacted us talk about developing multiple impulsive behaviors. Now, hypersexuality was a really significant one for Charlene. She also developed other forms of impulsive behavior, which, again, had significant consequences for her.
Charlene
There were so many things that I did compulsively. I would dye my hair day after day until it finally all started falling out and I had to shave it off. I was driving aggressively, getting into road rage incidents with people. One of them was spending money. So I'd go into any kind of clothing store and buy a lot of clothes, just spent money until there was no more money to spend anywhere, and there were no more credit cards I could get. And then I ended up taking out all of the retirement I had in a previous job and just kind of bottomed out.
Asma Khalid
Gosh. It seems like she did not understand the risks of the medication she was taking. And my understanding from your reporting is that it seems like the awareness of these drugs is not as high as it could be. So what's the history of this? Where does this all begin?
Noel Titheridge
Well, this goes back a long time, actually. You know, these drugs began to be used for a particular type of tumour in the 1980s. TUM that's called a pituitary gland tumor, but relatively at low levels. But then in the 1990s, they begin to be used for Parkinson's disease. You know, Parkinson's disease is the fastest growing neurological condition in the world. There are some 12 million sufferers, and that number's thought to be about to double before 2050 because of aging populations. But this drug was this time seen as a miracle medication. A previous generation of drugs used for Parkinson's had side effects all of their own. They cause involuntary movements, which are highly embarrassing for sufferers of Parkinson's. So these dopamine agonists are able to tackle the shakes and tremors that sufferers of Parkinson's face, but they also don't cause some of the involuntary movements. So these drugs then widely begin to be used for Parkinson's and then other conditions like restless leg syndrome, and in Charlene's case, depression.
Asma Khalid
And what exactly is restless leg syndrome?
Noel Titheridge
Yeah, restless leg syndrome is a condition which causes an uncontrollable urge to move. Many sufferers of this condition describe awful sensations, particularly late at night, that can cause chronic sleeplessness and really affect people's quality of life.
Asma Khalid
So, to be clear, when the medications first were put on the market, no one, it sounds, was talking about these side effects. You didn't hear this from doctors, you didn't hear this from researchers?
Noel Titheridge
Well, exactly. These hadn't appeared to any great degree, as far as we understand, in clinical trials. So you've got a situation where patients aren't aware, prescribing doctors aren't aware and they don't appear in leaflets at all. But our investigation found out that doctors did begin to share stories about the crazy, wild experiences that their patients were having. These side effects that led to huge debts, they led to the breakup of marriages, criminality and even in some cases, suicide.
Asma Khalid
I see. So you've outlined a timeline for us in which these drugs really started to become popularized in the 1990s through throughout the early 2000s. There's still no official report on the side effects, no warning that's being given to patients, but it appears there is some anecdotal evidence building that these drugs might not be safe for everyone. So when are these side effects, this anecdotal evidence, when does it actually first begin to be properly investigated?
Noel Titheridge
Well, academics in the early noughties begin to publish reports proving this link between these drugs and impulsive behaviour. And this is followed by clinical research by the pharmaceutical companies.
Asma Khalid
So this is the early 2000s then?
Noel Titheridge
Yeah, this is the early to mid 2000s. There's a significant study that finds that one in six people on these drugs develop impulsive behaviors.
Asma Khalid
Wow.
Noel Titheridge
Now, to kind of put that in perspective, health authorities here, they say that a side effect is very common if it affects one in 10 sufferers. So while not all side effects will be extreme or severe, some academics put the relationship even higher. They say one in three people are affected.
Asma Khalid
Oh, wow. I mean, that's staggering data to see in the side effects. And so once researchers detect that these side effects are indeed fairly common, once that is proven, why do the drugs stay on the market? I mean, presumably, I understand they are helping patients, but there has got to be some sort of tension looking at the pros and cons in that dynamic.
Noel Titheridge
Well, these drugs can be life changing for many people, particularly, we're told by Parkinson's sufferers, for them in the early stages of the condition. And regulators have always made these calculations that the benefits overall outweigh the risks. But what many people tell us, these people that have gotten in touch with us, that have experienced these side effects is, is that the complete scale of these side effects and the Nature of them. Everyone needs to be aware of it. So warnings do appear in the mid to late.
Charlene
And how.
Asma Khalid
So how are the warnings disclosed to the public?
Noel Titheridge
So they begin to appear in the leaflets, the packaging that you'll receive in the medication. In that small font.
Asma Khalid
It'll say that in that small font.
Noel Titheridge
Exactly. But what people say to us is that the warnings weren't sufficient enough. They hadn't been sufficiently warned to make the link between their newly developed impulsive behaviors and. And the drugs that they were taking until it was far, far too late.
Asma Khalid
So Charlene, in her story, she started taking these drugs 10 years ago. I find it hard to compute why, if the research was done, you're saying in the early 2000s, why someone like Charlene in the year 2016 was not aware of the risks of the medication she was on unless that information was not being fully disclosed? Right. You say that the risks were known, that they were beginning to be printed on leaflets. How do people continue then to take the drug and not know the side effects?
Noel Titheridge
Well, we've kept hearing the same complaints by people. One is that they weren't warned properly by their doctor. It wasn't taken seriously enough that there was a kind of like tittering or a kind of joke made about the sort of sexual side effects, when actually it was a lot more serious for these people when they developed. Other people complained about the language of the warnings, that they weren't clear enough.
Asma Khalid
What do they say? Do you have an exact language description?
Noel Titheridge
Yeah. So around sexually impulsive behavior, this term hypersexuality, that for a lot of people is quite hard to.
Asma Khalid
And what does that mean? Because isn't hypersexuality an actual disorder?
Noel Titheridge
It's compulsive sexual urges. So, you know, anyone can behave impulsively, but when impulsive behavior is deemed as harmful, that's considered an impulse control disorder. And hypersexuality is one of these kinds. And in the warnings that appear on leaflets, they talk about sexually altered interest, increase in libido, generally harmful behavior. But the people that developed extreme cases of these side effects, they say that the way that these manifest is often in porn addiction, in use of sex workers. And they're saying that that's the sort of language that they think the warning should include.
Asma Khalid
I mean, increased libido by itself doesn't sound particularly harmful.
Noel Titheridge
Well, and many men say that when they were told this in appointments in their 50s, 6 and 70s, they actually thought this might be a good thing. You know, when they were experiencing declining libidos, themselves. But if the language had talked about, you know, porn addiction and partners, families would would hear that language, they may be able to recognize these new behaviors when they emerge. But crucially, the, the other aspect of all this is that people say that some of these behaviors, sex addiction, gambling addiction, they can be really shameful. How do you tell your doctor in a brief appointment what you're going through? That's what stops a lot of people reporting this and getting into further and further problems.
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Asma Khalid
You've spoken in your reporting to hundreds of people. Did any of them bring legal cases against the drug companies, against their medical providers as a result of the side effects they experienced?
Noel Titheridge
Yes, some have. They appeared few and far between. So there are clinical negligence cases. That's where you say you weren't warned by your doctor. But this can be really hard to prove, right? So people say, how do you begin to evidence that your doctor didn't warn you about a side effect in an appointment that may have taken place, you know, a decade ago? Where there have been cases, generally they involve gambling. People that can say, look, I wasn't gambling before. You can see that through my bank statements. I begin taking these drugs and Look, I've lost $100,000. But with other forms of impulsive behavior, like sexually impulsive behavior, where relationships have been ruined, families have been broken up, how do you evidence the harm in those cases?
Asma Khalid
I imagine it's also difficult for the patients you've spoken to to weigh up how much agency they had. Right. Because I do think, particularly when you talk about sexual behavior changes, some folks might be wondering, well, hey, is this just not on me? People do change their sexual behaviors over their life, and is that just not a part of it? Do they wonder and do they struggle with how much agency they had?
Noel Titheridge
Yeah, that. That's a real theme here. So there's one particular case which is quite striking in that regard. It involves a family whose previously really respected father stole more than $600,000 from vulnerable elderly clients. So his legal practice involved having control of the financial affairs of lots of local elderly people in his community. But extraordinarily, he was stealing this money and he was paying for sex workers with the money. And bizarrely, he was using it to pay for antiques. One of his great hobbies was antiques. And he was spending huge amounts of money on antiques, stealing from his clients, more than a dozen people that lost huge sums of money. This story took a really tragic turn when the lawyer was sent to prison. But interestingly, the sentencing, the judge said that while the drugs were responsible for this man's behavior, he still felt he must have been able to spot his behaviour and he should have been able to warn someone and seek help from a doctor.
Asma Khalid
That is a really interesting ethical question.
Noel Titheridge
Exactly. And it's very tricky territory. But I think, as Charlene put it in one of the clips that we've played here, you know, you've got this dopamine hit loop and it changes your judgment. Where does the personality begin and where does the medication end?
Asma Khalid
I have to ask, what have drug companies said in response to your investigation?
Noel Titheridge
Yeah, so we've spoken to some of the manufacturers. They say that these drugs were extensively trialed, that they've been approved and continue to be approved by regulators around the world who make this benefit versus risk calculation. And they say that the side effects of are clearly stated.
Asma Khalid
So you say that drug companies put these warnings on the medication. Is it your sense that there is more that can be done to make these drugs safer somehow?
Noel Titheridge
Well, there have been attempts over the years. So one American academic paper said that there should be a black box warning on these drugs.
Asma Khalid
Like cigarettes?
Noel Titheridge
Exactly like cigarettes. You know, that extreme in terms of the potential side effects.
Asma Khalid
What font you're saying exactly?
Noel Titheridge
In big font. But the fda, the US drug regulator, said that it didn't feel that these side effects were sufficiently serious when compared with the benefits. And it said it's extensively evaluated this and issued multiple updates.
Asma Khalid
Okay, we want to know how Charlene's story Ends. You know, she talked about bottoming out. How does she finally realize what was happening?
Noel Titheridge
Well, Charlene had taken out $50,000 from her RET savings to fund her compulsive shopping. But soon that money dried up and she began shoplifting. And it's at this point, amidst all her other behavior, that she goes back to her psychiatrist.
Charlene
And I went to see her and said, you know, I think there's something wrong. Maybe I have bipolar disorder, because that was what I thought. And I remember her whipping around and she had a rolling chair, and she whipped around and said, it's the medication. She was 95% sure it was the medication, and she had to get me off of that medication. But even then, Noel, I was not convinced. I thought, there's. There's no way it's the medication. How could the medication do all that? In my head, that's what I thought, because that's how much I. I was unaware that something like that could happen.
Asma Khalid
Gosh. Does she go off the medication?
Noel Titheridge
Yeah, she does. But she says it's had a significant impact on her, that her depression has gotten worse. And she cites the PTSD that she developed from the sexual encounters and the abuse that she suffered as a cause of that.
Charlene
It's had a devastating impact. I mean, I'm still trying to recover. It gets me choked up to even talk about it a lot of the time. I know there are many people out there who are on this drug, and they have no idea of the damage that this can cause. So I think it's really important to get the word out there that there are other people who've been through this and you can make it through. And two, that it doesn't have to keep happening. This doesn't have to happen to them.
Asma Khalid
So, Noel, you started investigating these cases more than a year ago, and as we say, you've spoken with hundreds of people, hundreds of case studies people are still, in fact, getting in touch with you. So I just want to ask Noel here at the end what you've learned.
Noel Titheridge
Well, it's been an overwhelming experience. These are really difficult stories to hear. But there's also something really satisfying. Whenever we publish one of these stories, we're flooded with people getting in touch. And what's been really striking is the number of cases from people in the US where this seems a really underreported subject. You know, we've been approached by lots of people in America who are sort of saying, I've never seen this written about before. Thank God it wasn't just me. That this happened to me. But it feels to me that unless we can reduce the shame and the stigma that people suffer when they take these medications and experience these side effects, then they'll continue to be underreported. And unless people have true knowledge of the scale of the side effects and their consequences, how can they make truly informed decisions?
Charlene
Foreign
Asma Khalid
It's a really, really interesting story. Noel, thanks so much for bringing your reporting to us.
Noel Titheridge
Thanks so much for having me.
Asma Khalid
That was Noel Titheridge, an investigations correspondent at the BBC. And in response to Noel's investigation, the national drug safety regulator in the the UK has said it will begin reviewing the warning labels for several dopamine agonist medications. If you appreciated today's show and broadly the type of journalism that we bring you here on the Global Story, where we go in depth every day on one big story at the intersection of where America and the world meet, then I've got a favor to ask. Could you take a moment to write a review or rate us wherever you listen, it really helps other people find us. And by the way, if you all have questions for us, we love hearing from listeners. We want to know what stories you're interested in hearing. You can email us@theglobalstorybc.com Today's episode was produced by Viv Jones. It was edited by Bridget Harney and mixed by Travis Evans. Our video producer is Matt Pintus. Our senior news editor is Chyna Collins. And I'm Asma Khalid. Thanks as always for spending some time with us and we'll talk to you again tomorrow.
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Podcast: Global News Podcast (BBC World Service)
Date: April 12, 2026
Hosts: Asma Khalid, Noel Titheridge
Episode Theme:
An in-depth BBC investigation into a class of medications called dopamine agonists, prescribed for conditions like Parkinson’s disease, restless leg syndrome, and depression. The episode explores how these pharmaceuticals can cause life-altering side effects, including compulsive sexual behavior and gambling addiction, and why patients often aren’t warned.
Charlene’s Experience with Dopamine Agonists
Noel Titheridge’s Reporting and Background
Key Side Effect Profile
Problems with Medical Communication
Noel’s Reflections
Regulatory Consequence