Do you routinely prescribe anti-anxiety drugs to treat fear, urine-marking, obsessive behavior or aggression in your patients? Do your colleagues?
These drugs, though not as commonly used as antibiotics or pain medications, can drastically improve a pet’s quality of life and even save its life.
Treating behavior disorders has come a long way over the past few decades. The gold standards of training have changed dramatically since the 1980s, with forceful education being replaced by positive reinforcement.
For many veterinarians, animal behaviorists, trainers and even pet owners, the idea of using drugs to treat fear, anxiety or aggression is no longer a joke. However, not everyone has come all the way around.
Animals and Emotions
Some people, especially those outside veterinary circles, don’t accept that animals can suffer from anxiety, said Nicholas H. Dodman, BVMS, Dipl. ACVA, Dipl. ACVB.
“They think, ‘Animals? Anxious? I thought they were reflexive creatures,’” said Dr. Dodman, professor emeritus and former program director of the Animal Behavior Clinic at the Tufts University Cummings School of Veterinary Medicine.
“Animals having anxiety is still debated,” he said. “To me, it’s an argument that should have been dead a long time ago.”
When Dodman got started in the field of animal behavior he was told to get used to the fact that for certain conditions, such as urine marking, the only treatment option was euthanasia. A colleague also told him that fighting among cats sharing a household could be resolved only by rehoming one of the cats.
“That was bait for the bull,” said Dodman, whose latest book is titled “Pets on the Couch: Neurotic Dogs, Compulsive Cats, Anxious Birds, and the New Science of Animal Psychiatry.”
“I worked on both those problems,” he said, “and now both are resolvable. Urine marking was a death sentence in the ’80s because it couldn’t be treated with whatever they had available at the time. Now we can treat with minimal side effects and a high degree of success. It’s not a death sentence anymore.”
The results speak for themselves. According to Dodman, cats that urine-mark will respond with 90 to 100 percent improvement when administered fluoxetine (Prozac) and with no behavior modification.
Pet owners are facilitating the normalization of psychotropic drugs for animals. In the past, mental health issues may not have been discussed. Today, the topic is much less taboo.
“When mentioning to a client that their pet may benefit from psychotropic medication, it is not uncommon for that client to say, ‘I take that medication,’” said Kenneth Martin, DVM, Dipl., ACVB, of Veterinary Behavior Consultations in Austin, Texas. “When pet owners have sought treatment for their own mental health issues and have found personal benefits, they are more accepting of psychotherapy and corresponding medications for their pets.”
Timing is Everything
Psychotropic drugs are sometimes used as a last resort to treat severe issues such as aggression, compulsive disorders and fear—typically when behavior modification alone has failed. But employing them earlier in the process can lead to faster, better results, experts said.
In people, anti-anxiety medications may be used in conjunction with talk therapy. A similar approach works with pets.
“Treatment of behavioral health conditions in pets with medications should never be a last resort,” Dr. Martin said. “Many pets benefit from timely and appropriate use of behavioral medications when combined with behavior and environmental modification.”
Lisa Radosta, DVM, Dipl. ACVB, of Florida Veterinary Behavior Service in West Palm Beach, agreed.
“Animals are voiceless and their suffering emotionally often goes unnoticed,” she said. “One of the many questions I ask myself before I prescribe is whether the quality of life of the animal is affected. If it is, I strongly consider a medication or a supplement.”
Dodman said drugs can be a game-changer for aggression, the No. 1 behavior problem in animals.
“For some cases it can be managed with behavior modification alone,” he said, “but I tell people I can get there faster with a greater degree of success if I use medication as well.
“Fears and phobias are very difficult to treat without medication because fears, once learned, are never really unlearned.”
Some conditions respond better to psychotropic drugs than to any other treatment option.
“You’re not going to be able to treat a compulsive disorder without medication,” Dodman said. “These are the things that were refractory to just about all treatments that veterinarians threw at them in the early days.
“Take a lick granuloma in a dog,” he said. “Vets would put on various salves and balms and local anesthetics. They were trying to treat it topically. It’s not a topical condition; it’s in the brain. It’s a compulsive disorder. Now those conditions can be treated very effectively with the Prozac-type drugs, which among other things are anti-obsessional.”
For years U.S. veterinarians turned to three approved medications to manage behavior problems, each belonging to a different drug class:
- Reconcile (fluoxetine), a selective serotonin reuptake inhibitor (SSRI).
- Clomicalm (clomipramine) a tricyclic antidepressant (TCA).
- Anipyl (selegiline), a monoamine oxidase inhibitor (MAOI).
“All are on label for only canines, with Reconcile and Clomicalm on label for canine separation anxiety and Anipryl on label for canine cognitive dysfunction syndrome,” Martin said. “Of the three, Reconcile is no longer available on the veterinary market, yet its generic equivalent [fluoxetine] is still available.
“All of these medications are currently used in an off-label format for treating a wide variety of behavior problems in companion animals.”
Sileo (dexmedetomidine oromucosal gel), manufactured by Zoetis Inc., received U.S. approval this year for the treatment of canine noise aversion during events such as thunder and fireworks. Pet owners may administer the drug at home by dispensing the gel between the dog’s cheek and gum.
“Because the route of administration and the dosing syringe setup is unique for Sileo, it is important that the veterinarian spend time with pet owners to ensure that they understand how to use the syringe and how to administer the correct dose,” said Sharon L. Campbell, DVM, MS, Dipl. ACVIM, veterinary specialty operations medical lead for Zoetis.
“Additionally, when Sileo is absorbed oral transmucosally, the bioavailability of dexmedetomidine is 28 percent. This means that only about one-quarter of the administered dose is absorbed. The effects are dose-dependent and reflective of this lower drug exposure, resulting in calming not due to sedation—and minimal effects on heart rate, blood pressure and body temperature.”
Safety and Efficacy
Not all veterinarians routinely prescribe anti-anxiety drugs in behavioral disorder cases. The hesitancy might be due to a lack of comfort with the drugs and the conditions they treat, or possibly because of concerns about side effects.
“Veterinarians in my area are more comfortable prescribing psychotropic medications than in the past,” Dr. Radosta said. “However, that seems to vary by area as some colleagues in other areas report the opposite.”
Dodman stressed that the safety margin of behavior- modifying drugs is quite high.
“Anyone can use these medications,” he said. “It’s something everyone should know how to do.
“Most of the modern behavior-modifying drugs are perfectly safe and generally effective,” he added. “Most have very few side effects, and not serious ones. Most of them cause very little internal organ damage.”
If side effects occur, Dodman said, they often may be managed by skipping the drug for a day or two, then starting it again at a lower dose. If improvement isn’t seen at the starting dose and the patient is not experiencing side effects, the dose may be increased with relative safety.
The drug with perhaps the most value for veterinarians to learn to use is fluoxetine, Dodman said.
“It’s one of the safest drugs that ever came down the pike,” he said. “It’s so universally effective for a plethora of problems ranging from aggression to anxiety to fears to phobias and compulsive disorders that if a vet wants to become an expert in any one drug, Prozac would be the one to learn how to use.”
It’s not uncommon for a patient to require a higher dose of psychotropic medications over time, Radosta said. This is not necessarily a sign of the drug not working or the patient not responding.
Including behavior modification as part of treatment is vital in many cases, she said, to address the root cause, particularly in cases of fear. Medication alone will not always resolve the issue.
“The use of psychotropic medications in animals can be thought of as similar to the use of nonsteroidals in arthritic patients,” Radosta said. “They don’t cure the disorder but instead alleviate the clinical signs so that other modalities, such as cognitive treatments, can be instituted to slow the progression or cure the disorder.
“It would be expected that if an anxious patient is only administered medications that the primary disorder will progress and the patient will need more medication in the future to keep the clinical signs at bay.”
Radosta acknowledged that it can be tricky for general practitioners to seamlessly integrate behavioral modification into a patient’s treatment plan.
“Dog trainers are not licensed and often are unable to treat patients with emotional disorders adequately,” she said. “The best way to ensure the highest level of treatment is to train the veterinary health care team to treat emotional disorders. This can be relatively easily done, as continuing education is offered at every major veterinary conference and in webinars.”
Originally published in the October 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!