As many families will attest to, some triggers cannot be effectively managed. Some triggers are normal, everyday occurrences, situations, or objects. This could be the case for a cat who is afraid of a certain family member or a dog afraid of walking on concrete. These things are very difficult, if not impossible, to avoid.
There are a lot of factors that influence the manifestation of emotional disorders in both pets and people. You can read more about these in our article on Contributing Factors. The result is the same: inability to cope with stress. There are multiple hormones and chemicals responsible for an animal’s coping mechanisms. By increasing some and decreasing others, we bring these brain chemicals into better alignment and allow the pet to respond more appropriately to stimuli.
Emotional disorders can be compared to other conditions where there is a deficit in normal biochemicals. Diabetes Mellitus is a great example. In diabetes, the sufferer does not create enough insulin to use the sugar in their blood. We supplement the insulin with injections to help the patient function normally. With anxiety, the animal does not create enough coping neurotransmitters to manage stress normally. So, we supplement those chemicals to help the patient function normally.
The goal of medication is never to sedate the pet or change their personality. We want to keep all the enjoyable aspects of our pets, but help manage their fear, anxiety, and stress so that we can all live happier lives. In fact, if we do see dramatic changes in personality, play drive, sociability, etc. it indicates that the product or dose is inappropriate, and it needs to be adjusted.
Daily Medications
Most patients diagnosed with anxieties, phobias, or aggression disorders will benefit most from a daily medication. These are products that need to be given on a regular basis for 4-6 weeks before they take full effect. Daily medications include classes of drug such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic anti-depressants (TCAs). Some common medications include Prozac, Zoloft, Lexapro, and Paxil. As with any new medication, it is important to monitor for side effects. Most will occur within the first 7-10 days of starting or increasing, and include decreased appetite, nausea, sleepiness, and/or increased agitation. If these side effects are mild and short lived, we try to “power through” them. If they are significant and do not go away on their own, we adjust the product. As a general rule, daily medications are the least likely to have dramatic side effects because the body has ample time to acclimate.
We recommend a general organ function screening before starting a daily medication. This is not due to possible liver or kidney damage from the drugs themselves, but because we want to ensure there are no underlying medical conditions that could be influencing the behavior or may indicate certain classes of drugs be avoided. Assuming the labs are normal, most pets should have their values rechecked every 6-12 months while taking long term medications.
When starting a daily medication, the doctor will prescribe a low starting dose. This is to ensure we are using the lowest effective doses and to prevent side effects. After the appropriate loading period, the doctor will discuss progress and the two of you will determine if an increase is warranted. The goal of medication is to decrease the frequency and intensity of unwanted behaviors while improving the pet’s ability to recover after a stressful event. The pet should also be able to learn more effectively and use trained behaviors in practical ways.
Treatment Flow
Start Medication
Monitor for side effects.
If mild, monitor; if moderate-severe, contact your provider.
Assess at 4-6 weeks.
Discuss any changes in behavior
Compare lifestyle to target behaviors.
If reasonable improvement, maintain and focus on behavior modification.
If there is no or only some improvement, increase dose.
If there are inappropriate side effects, consider decreasing or switching.
Repeat every 4-6 weeks until an “ideal” response is achieved.
Situational Medications
In contrast to daily medication, situational products do not, or at least rarely, have a build effect. Instead, you give this medication 2 hours prior to a stressful event, it takes effect, it lasts x amount of time, is metabolized, and then wears off. These products are most often used episodically prior to unavoidable, but highly stressful situations. They can include things like long car rides, veterinary visits, large social gatherings, boarding, and more. Anything you anticipate causing your pet to go over threshold warrants the use of your situational medication(s).
Any time the doctor prescribes a new situational medication, be sure to try it at home in a neutral setting first. This is to ensure the pet tolerates it and has an appropriate response. All medications will have risks of side effects and we need to know if that is the case before using it in a scary situation. The most common issues will be GI related (nausea, vomiting, drooling, diarrhea) or cause inappropriate changes in mood or mentation (irritability or lethargy). If we see inappropriate side effects, we discontinue or adjust the dose. Sometimes there is a little bit of trial and error involved. The way in which a pet fails a medication, however, gives us important information and points us in the right direction.
Even though these are called “situational” medications, some dogs with particularly challenging behaviors will require their use multiple times per day, every day. We focus on the quality of medication, not quantity. A normal dog that takes Reconcile, clonidine, and gabapentin every day would be a puddle on the floor. A highly anxious, easily stressed dog will be able to function normally. We always focus on ensuring all the positive, appropriate aspects of a pet’s behavior and personality remain intact while better managing their anxiety and undesirable behaviors.
Practical Applications
To the left is a graph demonstrating a dog’s experience during a veterinary visit. It shows arousal over time. Arousal refers to emotional intensity or amplitude – it is not inherently positive or negative. A pet’s baseline is their emotional intensity at rest and the threshold is the level of arousal needed for specific behaviors to manifest. Along the bottom of the graph are various stimuli, environmental changes, and/or social interactions that cause a change in arousal levels.
It is normal for there to be fluctuations. When you have a pet with poor coping skills and/or abnormal brain chemistry, however, you see much larger spikes in arousal and longer recovery times. They also tend to reach threshold in situations that should not be that threatening. To the left is a graph demonstrating the same scenario as before, but experienced by an anxious pet.This is demonstrated to the graph on the left.
When using a combination of daily and situational medications, we can have the
response shown in the third graph.
Again, the goal of medication is not to change the pet’s personality or cause sedation. It is simply to allow these animals to better cope with their environment.
Common Medications
Reconcile (RECK-onn-sile)
· Dog-branded Prozac (fluoxetine), a selective serotonin reuptake inhibitor (SSRI)
· FDA approved for treatment of separation anxiety
· Daily medication; 4-6 week loading period.
Clomicalm (CLOE-mih-calm)
· Dog-branded clomipramine, a tricyclic antidepressant. (TCA)
· FDA approved for treatment of separation anxiety.
· Daily medication; 3-4 week loading period.
Sertraline (SERT-truh-leen)
· Generic Zoloft, a selective serotonin reuptake inhibitor (SSRI)
· Off label use for treating anxiety in dogs and cats.
· Daily medication; 4-6 week loading period.
Paroxetine (PUH-rocks-eh-teen)
· Generic Paxil, a selective serotonin reuptake inhibitor (SSRI)
· Off label use for treating anxiety in dogs and cats.
· Daily medication; 4-6 week loading period.
Clonidine (CLONN-uh-deen)
· Used as a blood pressure and sleeping aid in humans.
· Blocks release of norepinephrine, a chemical released in the fight-or-flight response.
· Off label use for anxiety in dogs. Not used in cats.
· Situational medication; lasts 6-8 hours.
Trazodone (TRAZ-oh-done)
· Used to treat depression and as a sleeping aid in humans.
· Increases serotonin levels.
· Off label use for anxiety in dogs and cats.
· Situational medication; lasts 8-12 hours.
· If given consistently for 2+ weeks, has similar effects to SSRIs.
Gabapentin (GABB-uh-penn-tinn)
· Used to treat pain, seizures, and anxiety in humans.
· Increases brain’s access to calming neurotransmitters.
· Off label use for anxiety and pain in dogs and cats.
· Situational medication: lasts 8-12 hours.
Lorazepam (LORE-azz-uh-pamm)
· Used as an anti-panic medication in humans.
· Increases levels of calming neurotransmitters.
· Off label use for anxiety in dogs and cats.
· Situational medication; lasts 6-8 hours.
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