Behavior problems arising from the limitations imposed by the modern urban environment can be complex and difficult to treat. Anxiety is often a factor. In such situations, medication can help with treatment success.
Is Medication Necessary?
Some pet parents don’t want to give their dog behavioral medication. They’re not comfortable treating behavior issues with drugs and would rather resolve the problem through training and behavior modification. This reaction is understandable. However, some problems can be resolved more quickly and with less distress (for the dog and the pet parent) if behavior medication is added to the treatment plan.
In an ideal world, the most effective approach to treating a behavior problem is behavior change training. Behavior modification treatments designed by knowledgeable, qualified professionals treat the problem behavior by either changing the dog’s perception of a situation or a thing, by changing the consequence of the dog’s behavior, by giving the dog an acceptable behavior to do in place of the problem behavior, or by a combination of these things. (Please see our article, Finding Professional Help, for help choosing and locating a qualified expert in your area.)
However, with many problem behaviors related to fear, medication is necessary to reduce the dog’s fear to a level that allows treatment to begin. Please see our article, Desensitization and Counterconditioning for information about these effective treatments that are commonly used for fears, phobias, anxiety and aggression.
Can Medication Be Used Instead of Behavior Modification?
Behavioral medication alone isn’t usually effective for resolving a behavior problem. For the dog, medication serves to make a situation tolerable but not necessarily acceptable. Behavior modification can then be used to make the situation acceptable. For instance, if a dog is afraid of thunder storms, medication can ease the dog’s fear enough that he can tolerate the storm and undergo the counterconditioning necessary to treat his fear. But it’s the counterconditioning that helps him overcome his fear. In addition, many dogs can develop behavior habits because of a problem that requires medication. The medication can help the core problem, but behavior modification is still necessary to treat the accompanying behavior habits.
Which Medicines Are Best for What?
Five types of medicines are usually used to treat behavior problems in dogs. These are benzodiazepines (BZs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). The following is a table that shows different behavior problems in dogs that have been successfully treated with behavior change training and medicine.
Behavior Problem | Medicine Type |
General Timidity and Fear of New Things | TCA, SSRI, 5-HT agonist |
Thunderstorm or Noise Event Phobia | BZ, TCA |
Distress at Being Left Alone (Separation Anxiety) | BZ, TCA |
Compulsive Behavior (repeating the same short response or sequence over and over again) | TCA, SSRI, 5-HT agonist |
Excessive Licking | TCA, SSRI, 5-HT agonist |
Cognitive Dysfunction | MAOI |
Medicines for the Treatment of Sudden or Severe Fear and Panic
Some dogs experience fear only in specific situations, such as during fireworks or other events with loud noises. The benzodiazepines can help in these situations by reducing fear as needed right when these situations occur. Benzodiazepines take effect quickly, so they can treat impending fear within a short period of time-the same way an aspirin relieves a headache shortly after you take it. In contrast, most other drugs for alleviating fear need to be taken daily for several weeks before they produce results-just like antibiotics need to be taken a few days before they begin to fight bacteria. A minor drawback is that BZs must be given to the dog before the fearful event begins. Optimally, the medicine should be given one hour before the beginning of the scary event, or at minimum, it should be given before the dog shows any signs of fear or worry, such as stress panting, trembling, tail tucking, pupil dilation, sweating paw pads, etc.
Some common benzodiazepines are diazepam (Valium®), alprazolam (Xanax®), chlordiazepoxide (Librium®), lorazepam (Ativan®) and clonazepam (Klonopin®). Benzodiazepines work by increasing the activity of a chemical in the brain that interferes with activation of the fear networks.
Dose Effects
You can only know if a drug is working if you have an idea of what effects to expect. The following list provides the expected reactions in dogs to different doses of benzodiazepines:
- At low doses, benzodiazepines ramp down excessive behavior and reduce excitability.
- At moderate doses, benzodiazepines reduce anxiety. Dogs who are afraid will be less fearful and more likely to act normally. At these doses the drug can also increase friendly and interactive behavior.
- High doses of benzodiazepines produce sedation, including impaired movement and thinking, and disorientation. They also produce sleepiness and cause vomiting. Benzodiazepines affect some of the same parts of the cells in a dog’s brain as alcohol, and so they produce similar effects.
Side Effects
Benzodiazepines have some unwanted side effects, including increased appetite and sleeplessness. Sleeplessness may seem contradictory, but this medicine can actually produce increased anxiety in some dogs. Although not common, this side effect seems to occur most often when the medicine is given after the dog has already begun to show signs of anxiety.
Medicines for the Treatment of Sudden or Severe Fear and Panic continued...
Benzodiazepines are also inappropriate for the treatment of aggression, because they can sometimes reduce inhibition. This means that although the dog may not react as quickly to a frightening or disturbing event, if he does react he might behave aggressively. Lastly, benzodiazepines can cause addiction if they are given many times a day for more than three weeks.
Benzodiazepines can also interfere with learning and memory, so they aren’t good choices for long-term use with training and behavior modification. Because of this, if a benzodiazepine is necessary because of excessive anxiety or fear, this type of medicine is best used initially and then gradually discontinued.
Health Issues
Benzodiazepines are metabolized in the liver and excreted through a dog’s kidneys, so if your veterinarian advises you to treat your dog’s fear with a benzodiazepine, she should check with a simple blood test to make sure that these organs are working well before beginning treatment. If your dog has had problems with his kidneys or liver, be sure to let your veterinarian know.
Medicines for the Treatment of General Anxiety
Some dogs suffer from a more generalized form of anxiety that leaves them nervous in many everyday situations. Benzodiazepines are not a good choice for everyday, ongoing treatment, so they aren’t appropriate for dogs with generalized anxiety. These dogs do better with treatment that can be continued for a period of time rather than given in anticipation of frightening events. The medicines that help dogs with general anxiety problems are TCAs, MAOIs and SSRIs.
Tricyclic Antidepressants
Tricyclic antidepressants (TCAs) were originally used to treat depression in people. They work primarily by increasing serotonin and norepinephrin-two neurotransmitters that are involved in regulation of emotional activity. They also affect other neurochemicals involved in emotional reactivity. The TCAs prescribed most for dogs are amitriptyline (Elavil® or Tryptanol), clomipramine (Clomicalm® or Anafranil®), doxepin (Aponal®), imipramine (Antideprin or Deprenil), desipramine (Norpramin® or Pertofrane) and nortriptyline (Sensoval). Every dog is unique behaviorally and physiologically, so one TCA might not work well in a dog whereas a different TCA in the same dog could have excellent results.
Although TCAs were originally labeled to treat depression, they also reduce anxiety, manage compulsive behavior and can help people with anger problems. In dogs they have been used successfully to help with treatment of separation anxiety, general anxiety and compulsive behavior problems like compulsive licking. For instance, amitriptyline is a good choice for treating generalized anxiety and separation anxiety. Studies have shown that clomipramine is quite beneficial when used in combination with behavior modification for treating separation anxiety. This medication is approved for dogs by the FDA. (It’s sold under the name Clomicalm®.) It‘s also effective for reducing compulsive behavior.
to be continued...
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