Behavior Medication: First-Line Therapy Or Last Resort?

Behavior Medication: First-Line Therapy Or Last Resort?

Today, I want to shed some light on a sometimes confusing, often maligned topic in the field of dog training – namely, the use of medication to treat behavior problems.

You may have strong opinions about this already, and that’s okay.  Many of my clients do.  My goal with this discussion is not to convince you of anything in particular, but simply to provide information and clarify some misunderstandings that I often see.  Medication may be an excellent, life-changing choice for some dogs, and not recommended at all for others.  As with so many things in behavior, there is no “one size fits all.”

First, let’s take a moment to outline what we mean by “medication.”  After all, this term can encompass lots of different things!  I’m using it here to mean prescription drugs, although I will also touch briefly on some natural calming aids and supplements that I’ve had success with in some cases.

For our purposes today, I want to discuss two main types of behavior medications.

The first type is a daily medication, given every single day without fail regardless of what is going on.  SSRIs (selective serotonin reuptake inhibitors) like Prozac, Zoloft, and Paxil fall into this category, as well as TCAs (tricyclic antidepressants) like Clomicalm.  These drugs need to be in the dog’s system at a steady state all the time in order to work – think of them as “background meds,” quietly doing their job 24 hours a day.  Effects are usually fairly subtle, and it can take several weeks to see benefits so they are definitely not a quick fix!  But in some dogs, these medications can be extremely helpful as part of a long-term treatment plan.

The second type is a situational medication, given only “as needed” for a specific problem.  Commonly used drugs of this type would include short-acting anti-anxiety meds like Xanax, Valium, trazodone, and even tranquilizers like acepromazine on occasion.  Meds like this are commonly used for problems like thunderstorm phobia or separation anxiety, and are only given at the time they are needed.  The anti-anxiety effects of these drugs are usually much more dramatic and they work very quickly, but side effects (most notably drowsiness) are also more pronounced… as with everything else, there are trade-offs!

So, now that we have a basic understanding of what kinds of medication we’re talking about, let’s get into the crux of the issue: what do these meds do, exactly, and why would we want to use them?

Simply put – if all goes well, they give us a level playing field for the rest of our treatment plan.

It’s important to realize that there is a critical difference between dogs with truly abnormal behavior issues (inappropriate aggression or reactivity, separation anxiety, thunderstorm or noise phobias, etc.) and dogs who have training problems like jumping on people or not coming when called.  Dogs with training issues don’t need medication – period.  They need patience, consistency, and a good training plan to teach them what we want.

But for dogs with more serious behavior issues, it’s often difficult or even impossible for them to learn until we address their underlying anxiety.  The brain chemistry of a dog who responds to every stranger or novel object as a terrifying threat is fundamentally different from a dog who accepts these things in stride.  The same is true for a dog who panics every time his owner leaves – his heart rate soars, he salivates uncontrollably, and his system is flooded with adrenaline.  These are real, physical changes that preclude any kind of learning until we can get them under control.

Can we address this anxiety through training alone?  Theoretically, yes – one of the hallmarks of an effective behavior modification plan is that the dog is always kept “under threshold,” meaning that we never push the dog to the point where he becomes anxious or upset.  But as a practical matter, for many dogs with issues like this, it can be very difficult to find a starting point where the dog is truly relaxed and able to learn.

This is where medication can be incredibly helpful.  Does it solve the problem on its own?  No, of course not.  But it can certainly make life easier for everyone involved!

Used properly, a daily medication like Prozac can help your anxious or reactive dog in three ways.  First, you should notice that it takes a bit “more” to cause an anxious or aggressive response than before – essentially, the dog has a longer fuse.  Second, if there is a reaction, it should be less intense.  And finally, it should be easier to distract or redirect the dog once the reaction has started.  These are all incredibly helpful changes – for implementing a training plan successfully, and also for the dog’s quality of life.

Similarly, a situational medication like Xanax or trazodone can be life-changing for a dog with severe separation anxiety or thunderstorm phobia.  These meds can help to block the automatic panic response that your dog may have when you pick up your keys to leave the house, or the first distant rumble of thunder is heard.  It’s still important to have a comprehensive treatment plan in place, since we want to teach the dog to associate good things (like yummy treats or playtime) with these situations – but the medication is what keeps him calm enough to be interested in treats or play.

Even with these benefits, I know that many owners have deep-seated concerns about using behavior medication – and I definitely understand this!  No one wants to put their dog at risk for dangerous side effects, or change their personality and lose the spark that makes them who they are.  And so, I want to address some common questions and concerns that I often encounter during behavior appointments when the subject of drugs comes up.

Is it safe? 

Fortunately, the answer to this question is overwhelmingly YES.  The most commonly used behavior medications in dogs (including Prozac, Clomicalm, Xanax, and trazodone) have been in widespread use in the veterinary field since the 1990s.  They are very well-tolerated by the vast majority of dogs, even in cases where they are used for many years.

As with any long-term medication, it’s always recommended to have yearly blood work done to make sure everything is normal – the same is true for humans!  But, it would be extremely unusual to see any problems.  I personally have never had a single patient develop any lab abnormalities or serious health issues as a result of taking behavior medications (knock on wood!), so I can vouch for the fact that this would be quite rare.

There are some chronic health conditions that may affect our choice of medication for a particular dog (such as epilepsy or liver disease), but this has more to do with how the medication might be processed by the body than any inherent danger of the drug itself.

What are some possible side effects?

It’s true that all medications can have side effects, and this is a valid concern – no one wants to “improve” behavior by drugging their dog into sleeping or staring at the wall all day.  Unfortunately, this worry is based on a grain of truth since many of the older behavior drugs (such as amitriptyline, and to a lesser extent clomipramine or Clomicalm) were notorious for causing a lot of sedation and lethargy, which many owners didn’t like.

Newer, more commonly used medications like Prozac generally don’t have this effect at all – and if they do, we drop the dosage or change to a different medication.  Sedation is NOT the goal.  The goal is to help your dog cope with his anxiety more effectively, without changing anything else about his personality.  If we see sedation or other unwanted side effects, we can always stop the medication and try something else.

I generally see very little in the way of side effects with Prozac and other SSRI’s, but the most commonly reported possibility is decreased appetite.  This is normally mild, and resolves on its own within a week or two in most dogs.

Situational medications like Xanax and trazodone can certainly cause some significant sedation and uncoordinated behavior, but these are short-acting drugs that clear the system within a few hours – and because they’re only used when needed, this generally doesn’t cause any problem at all in the dog’s daily life.

Will my dog have to stay on it forever?

This is always a tough one to answer!  The best, most honest response I can give is – MAYBE.  For most of my patients who are on medication, our initial goal with training and management is to reach the point where things are going well, and both dog and owner are happy.  When things have been going well for six months, we can try weaning off of meds to see how things go.

In many cases, the dog has learned better coping skills by this point (and the owner has become more skilled at managing things!), so the medication is no longer needed.  For others, the old behavior issues begin to pop up again once the dosage is reduced – in cases like this, it’s a perfectly reasonable to option to stay on medication long-term.

Finally, I am often asked about natural alternatives to prescription medication for anxiety or aggression.  There are definitely some great options out there that you may find helpful!  In my experience, their effects tend to be quite subtle so these things are often not enough for a dog with a serious problem – but, they can certainly be helpful for some dogs and there’s no harm at all in giving them a try.

Zylkene – This is a natural calming aid that contains casein, a milk protein that has been shown to have a relaxing effect in dogs and cats. It comes as a capsule that can either be given whole, or opened and sprinkled in the food.  This is a newer supplement, so I have less experience with it than some of the others listed, but have seen some good results.  It can be used daily, or “as needed” for thunderstorms, grooming, vet visits, etc.

Composure – Another all-natural calming aid. It contains l-theanine (which is found in green tea, and increases dopamine levels in the brain to help reduce stress and anxiety), C3 colostrum complex (another type of milk protein), and thiamine or vitamin B1, which can also have a calming effect in animals.  It comes as a flavored chew that most dogs will take quite readily as a treat.  Several of my patients have seen very good results with Composure, so it’s definitely worth a try if you want an alternative to medication.  Like Zylkene, it can either be used daily or as-needed.

Adaptil (DAP, or dog appeasing pheromone) – This is a dog-specific pheromone that can be used as a collar or a plug-in diffuser. Essentially, it’s a synthetic version of the pheromone that a mother dog produces when nursing her puppies – obviously a very comfortable, relaxed environment for the pups!  Adult dogs still retain the neurologic “wiring” needed to detect this pheromone and respond to it, so it can be helpful in promoting relaxation and relieving stress.

My personal experience with DAP is that its effectiveness seems to vary quite a bit from one individual to another – some of my clients swear by it and feel strongly that it helps their dogs, while others have seen no effect at all.  So give it a try if you like – both the collar and diffuser need to be replaced every 30 days, so I always suggest trying it for a month to see if it works for your dog.  If it does, keep using it!  If not, no harm done.

It’s always best to check with your vet before starting any kind of new supplement, but in general all of these options are extremely safe and can be ordered without a prescription.  In my experience, natural supplements are often not enough for dogs with serious behavior problems, but they can certainly be a good starting point.  And if your dog’s issues are fairly mild, they may work very well along with training and management.

So, where does that leave us regarding our original question?

I will share my closing thoughts on this topic, but I certainly always welcome other opinions as well – feel free to comment if you have an alternative viewpoint.

In my opinion, medication should be considered as a first-line treatment option for the vast majority of dogs with true behavior problems – including aggression, compulsive behavior issues, and any type of pathological anxiety.  When we try to reserve the use of drugs as a last resort, something that we only try if the case is “really bad”, or if nothing else has helped, I believe that we do these dogs a tremendous disservice.

To me, this is similar to saying that we don’t want to use insulin in a diabetic patient unless he’s crashing with DKA, or that we don’t want to treat an infection with antibiotics until full-blown sepsis sets in – it makes no sense to withhold a basic treatment option with minimal risks and lots of potential benefits, until the situation becomes truly desperate.

Far better, if we can, to prevent this from happening in the first place with a well thought-out, comprehensive treatment plan in the beginning.

8 thoughts on “Behavior Medication: First-Line Therapy Or Last Resort?

    1. An excellent question! If the dog has been on it for more than a week or two, then yes – it should be tapered down gradually and then stopped.

  1. Excellent post, many thanks. Have you seen dogs habituate to the longer-acting drugs, like Prozac? Do you find you need to increase the dose to maintain effectiveness?

    1. A very good question! I have not seen this with Prozac or other SSRI’s, and we wouldn’t expect it to happen due to the way that these drugs work – this is actually one of the reasons that these meds are well-suited for long-term use. Many dogs are on them for years, or even their whole lives if needed, with no need to continue adjusting the dose.

      But, it’s quite common for this to happen with benzodiazepines like Xanax and Valium – when used long-term, dogs do develop a tolerance and often require dosage increases over time. This is why we try hard to use these meds only “as needed”, rather than daily.

  2. Thank you for this excellent discussion. Our highly anxious/reactive Habi is a poster child for Prozac, which our behavioral vet put her on immediately after meeting her nine years ago, It took about three months before she was able to think rather than react in a situation, and at that point our efforts at behavioral modification began to take hold. It’s been a long, bumpy and immensely rewarding road. We finally weaned her off it two years ago, when she was ten, and the foundation we had built was solid enough that she’s doing great ‘cold-turkey’ (the same was not true when we trialed her off it after a year).

    I started out very anti-drug (especially long-term drug!), but in Habi’s case Prozac was appropriate.

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