Dopamine Dysregulation from Overuse of Mucuna pruriens Levodopa

The scientific paper by Sohutskay et al., titled Dopamine Dysregulation Syndrome Presenting as Overuse of Mucuna pruriens Levodopa Supplement, presents a rare case of Dopamine Dysregulation Syndrome (DDS) linked to the excessive use of an herbal levodopa supplement in a patient with Parkinson’s disease. Published in The Journal of Movement Disorders in 2024, the study highlights the potential dangers of unsupervised use of Mucuna pruriens, a natural product commonly marketed as an alternative treatment for Parkinson’s symptoms. Despite its plant-based origin, Mucuna pruriens contains variable and sometimes high levels of levodopa, the same active compound used in standard pharmaceutical treatments, which can lead to serious side effects when misused. This case underscores the importance of clinician awareness and patient education regarding the risks of alternative dopamine therapies.

This summary is based on a 2024 scientific paper published in the Journal of Movement Disorders. It tells the real story of a woman with Parkinson’s disease (PD) who developed a serious condition called Dopamine Dysregulation Syndrome (DDS) after overusing a natural supplement called Mucuna pruriens.

Mucuna pruriens, also known as the velvet bean, is an herbal supplement often marketed as a “natural” treatment for Parkinson’s. What makes it attractive to patients is that it contains levodopa, the same active ingredient found in many prescription medications used to treat PD symptoms like tremors, stiffness, and slowness of movement.

Some people think herbal supplements are safer than prescription drugs, but this study shows that isn’t always true. The supplement may have contributed to serious health problems for this patient.

DDS is a condition where a person overuses dopamine-based medication, even when it causes harm. It can lead to strange behavior, mood swings, hallucinations, and even psychosis. According to the authors, “this is the first case report describing DDS presenting as excessive use of commercial levodopa supplements in a patient with PD.”

This story is a reminder that “natural” doesn’t always mean safe — especially regarding the brain’s delicate chemistry.

The scientific paper focuses on one patient with idiopathic Parkinson’s disease, meaning her condition had no known cause. She was diagnosed at age 47, and her treatment and behavior were tracked over more than 10 years.

Doctors reviewed:

• Her medical records
• Results from neurological exams
• Observations from hospital stays
• Feedback from her family

They also carefully examined how she used both prescribed medications and the Mucuna pruriens supplement. The goal was to see how her condition changed over time, especially after she began relying heavily on the supplement.

Notably, her responses to different types of treatment, her side effects, and how much insight she had into her behavior were all part of the analysis.

The patient was first seen by a neurologist for a unilateral tremor at age 47 and was diagnosed with Parkinson’s disease. She started on carbidopa/levodopa immediate-release (IR) — a standard Parkinson’s medication. However, she soon stopped taking it, reporting side effects like nausea, anxiety, and skin itching.

Her symptoms were mild at the time, so she lived without treatment for several years. By age 52, though, her tremor and difficulty walking had worsened. That’s when she decided to restart therapy.

At age 54, she added Mucuna pruriens to her medication plan. She chose this herbal supplement because she preferred what she believed was a more “natural” approach. The study notes, “She attributed her use of these supplements to interest in a more natural means of treating the disease.”

By age 55, she experienced her first episode of hallucinations and paranoia, which doctors believed was connected to her dopamine therapy. These symptoms improved after a brief hospital stay but returned later — stronger and more frequent.

At age 57, her family noticed she was taking more Mucuna pruriens than prescribed, which led to her being hospitalized again. Doctors saw signs of dyskinesias — uncontrolled, jerky movements that can happen when dopamine levels are too high.

The care team switched her from carbidopa/levodopa IR to extended-release (ER) capsules, thinking a more stable dose might help. She continued taking Mucuna pruriens, even though it was contributing to her worsening symptoms.

Between the ages of 57 and 59, she was hospitalized several times. Her symptoms included:

• Severe agitation
• Vomiting
• Psychosis, including “ Othello syndrome,” a rare delusion involving false beliefs about a partner’s infidelity
• Restlessness and insomnia, often working on household tasks at night for no reason

She began hiding her medication and admitted to taking 3 to 5 capsules of Mucuna pruriens every 3 hours, depending on how she felt. Her husband later revealed that she was buying the supplement from an online source without telling anyone after he had warned her to stop.

At one point, she consumed about 100 capsules over two days and ended up in the emergency room. The study describes her as “restless, with pressured speech” and saying things that didn’t make sense. By the next day, her speech slowed, her facial expressions were blank (a symptom known as hypomimia), and her movements became sluggish.

Throughout her treatment, she “lacked insight” into how serious her condition had become. Even though her doctors and family told her to reduce the supplement, she kept taking it — often in secret.

After many hospital stays and no lasting improvement, her family made the difficult decision to move her to a long-term adult care home. Doctors finally discontinued the herbal supplement and placed her on a stable treatment plan using only carbidopa/levodopa ER.

This case shows how dangerous self-treatment can be, even when someone is using an over-the-counter product.

The study raises serious concerns about using herbal supplements without medical advice. Mucuna pruriens may seem appealing because it comes from a plant, but it contains a powerful drug — levodopa — that affects the brain.

The problem is that Mucuna pruriens is not regulated like prescription drugs. According to the study, “the levodopa content of Mucuna pruriens extracts is quite variable,” and “the measured amounts can range from nearly negligible to more than twice the stated dose.” This makes it very hard to know how much medicine a person gets.

Also, taking dopamine in an “on-and-off” (pulsatile) way, as this patient did, increases the risk of developing DDS. These sudden highs and lows can “change dopamine signaling in the brain,” making the person feel like they need more medication, even when it’s hurting them.

The authors also mention something called " levodopa phobia ” — where patients are afraid of using standard medications and turn to supplements instead. This fear can lead them to make risky choices, like the patient in this study.

Doctors should:

• Ask patients if they are using any supplements, especially those sold online
• Explain the risks of unregulated treatments
• Watch for signs of DDS, such as hiding pills, taking extra doses, or acting impulsively

Patients and caregivers need to be aware of how powerful these supplements can be — and how important it is to talk openly with a doctor about treatment decisions.

This scientific paper tells the first documented case of dopamine dysregulation syndrome caused by the overuse of Mucuna pruriens, a supplement that contains levodopa. Even though it’s plant-based and easy to buy online, it can still lead to serious side effects, including psychosis, addiction-like behaviors, and repeated hospitalizations.

For people with Parkinson’s disease, using any treatment — even a “natural” one — requires careful monitoring. This case shows that unsupervised use of herbal supplements can become dangerous, especially when someone loses control over how much they’re taking.

The big takeaway? Always talk to a doctor before starting or changing any part of your Parkinson’s treatment plan. When managing brain chemistry, safety and supervision matter as much as the medicine itself.