Thursday, January 12, 2012

Why People are Resistant to Behavioral Meds for their Dogs... And Why You Shouldn't Be

As a dog trainer, it is rare that I recommend people consult with their vets about the use of anxiety medications. Most dogs simply don’t need them. When I worked at a big box store, I never once ran across a dog who I thought needed meds. However, now that I work exclusively with people who have dogs with behavior issues, I naturally see more dogs that might benefit from a little chemical help.

Thankfully, many of these dogs improve over the course of a six-week class. So much so, in fact, that by the end I do not feel the need to refer them for a medication consultation. For some, I mention that if their progress stalls out or if their dog regresses, they might want to consider using meds, but it’s more to educate them about their options than a serious recommendation.

But then there are the dogs that do not improve, or who get worse. The dogs who are so hypervigilant that they cannot learn anything in class. The dogs who cannot eat or otherwise be distracted from the mere sound of another dog. The dogs, in other words, who probably could benefit from the use of medication.

It’s a fine line I walk. I am not a vet, and as a result, I cannot tell someone that their dog needs medication. I cannot diagnose their dog with a clinical disorder. I cannot tell them which medication is right for their dog, nor the dosage. But I can urge them to consult with someone who can.

Some people- bless them- follow up on my recommendation. But others steadfastly refuse. Why? There are a number of reasons- probably as many as there are owners- but here are what I think are the top five… and my response to them.

1. Treating animals with human medication is silly and anthropomorphic.
I’ve heard this one a lot, and on the surface, it makes sense. They are dogs, not people. Why would we use human treatments? The funny thing is, though, that this objection is only raised in relation to behavior meds. The truth is, there are lots of medicines that have both veterinary and human applications. Antibiotics are an obvious example, but plenty of dogs take thyroid medications, insulin, pain meds, or allergy pills. In fact, this is so common that several major (human) pharmacies even have a pet prescription savings plan!

What’s more, I do not think it is anthropomorphic in the least to think an animal can suffer from anxiety. They have nearly identical brain structures to ours, so it seems not only possible, but also quite likely, that they might suffer from some of the same mental disorders that we humans do.

2. All vets want to do is prescribe medication. Everyone knows that meds are overprescribed in this country!
I’m sure this objection is a carryover from human medicine- it’s trendy to say that doctors overdiagnose and overprescribe ADHD meds, for example- but as a social worker who works with children, I have to say I see far more kids who could benefit from medications, but aren’t on them, than kids who are on them and shouldn’t be.

Adding to that, when I first explored the concept of medication for my own anxious dog, my general practice vet said she didn’t need them. Anecdotal evidence to be sure, but I’ve heard the same story from plenty of other people.

This objection is also why I have a personal preference for referring people to a board-certified veterinary behaviorist. My experience has been that they do not prescribe meds to every dog that walks through their doors. In fact, the last person I referred was told that their dog would not benefit from medication.

3. I’m worried about the side effects. I’ve heard these meds can hurt my dog, or cause his personality to change.
This is a very valid concern. You should not walk into medication use blindly. When you consult with a veterinarian about medication use, you should ask what the side effects might be, as well as potential drug interactions. Your vet should also give you information on when and how to follow-up, and advise you regarding blood work to monitor your dog’s systemic function.

That said, these drugs have been well-studied and considered generally safe. Every dog will react differently of course, but I personally believe it is worth the risk, especially when you consider that the effects of long-term anxiety on the body may be even more detrimental than the side-effects of medication. A quick google search will reveal that the effects of untreated stress include a compromised immune system, gastrointestinal distress, heart problems, and musculoskeletal pain.

So far as personality change, this should not happen. If your dog seems drugged, zombie-like, or somehow different, he may be on the wrong medication or the wrong dose. Talk to your vet. My dog is different on medication, it’s true, but it’s like a radio: the volume has not been turned down at all. Rather, the static of anxiety has been filtered out so that her personality can come through more clearly.

4. It’s too expensive. Times are tough, and I just can’t afford it.
It’s true, the initial appointment, follow-ups, blood work, and even the cost of the medication itself all add up. But so is the cost of ongoing training. My dog and I spent two years in weekly training classes before trying medication. After starting meds, she was able to graduate within six months.

Also, keep in mind that the ongoing cost of medication does not need to be high. Many of the meds prescribed for anxiety have a generic equivalent; my dog’s medication costs less than $10 a month. Shop around for the best price- some drugs can be as low as $4 a month at the right pharmacy.

5. But what will people think? I don’t want people to think my dog is crazy. For that matter, I don’t want people to think I’m crazy for doing this!
I think this is the hardest objection to overcome. The social stigma surrounding mental health concerns and treatment is strong for humans and animals alike. Although we don’t think people (or animals) are “less than” if they have diabetes, cancer, or thyroid problems, we look down on them if they have depression, anxiety, or another mental illness.

Look, either way, it’s a physical problem. Sometimes it’s in the heart, and sometimes it’s in the brain. Illness can be treated no matter what part of the body is causing it, and I don’t think we should avoid treating our sick dogs just because it’s in the brain.

This is also why I am so honest and transparent in this blog. I want people to know there is no shame in using medication if that’s what’s right for your dog (or yourself!). I don’t think it should be the first thing you try, but I don’t think it should be your last resort, either. Medication can be a very helpful addition to any well thought out behavior modification plan.

People often email me, telling me that my blog inspired them to seek medication for their own dogs. Almost every one of them tell me that the only regret they have is waiting so long to do it. I share the same sentiment. I can’t believe I wasted so much time, and let my dog suffer with so much anxiety, because of my own pre-conceived notions of what it would mean to give my dog medication.

So, consider your options carefully. Ask questions. You’re right to be hesitant- you care about your dog, after all, and just want what’s best for him- but be open to the idea that medication might be just what he needs.

9 comments:

Ninso said...

Love!

Laura, Lance, and Vito said...

And #6. I feel like I am admitting defeat and have failed my dog.

Crystal Thompson said...

Ooh, good one, Laura. I felt that way, too, although the feeling intensified after Maisy started medication and was doing so well. It made me feel like I must be a really crappy trainer if a pill could do what I couldn't. Later, it felt like cheating, like if I'd been a better trainer I wouldn't have had to resort to that.

Eventually I realized that if she had been diabetic, I wouldn't have been able to train her blood sugars into being normal, so why did I expect that I could train her brain chemistry imbalance into normalcy?

More than that, several months later, the medication started making Maisy feel so much better that she started doing some scary things- rushing at dudes, snapping at children, etc.- and I had to intensify my training efforts. We got through it, but it made me appreciate that meds work best in combination with training. Meds only prime the brain to receive the training. The training is still important, and I still had an important role.

Now I know that I didn't fail her and I didn't cheat. In fact, I was a damn good owner: I was persistent enough to keep looking for answers, open-minded enough to think outside the box, and selfless enough to swallow my pride to help my dog.

Sam said...

I myself have also heard all of these excuses from various people in the class I've either taught or run my own dog in. It is very difficult to explain to a person who is unfamiliar with brain chemistry the idea of using medication to make the "usual" training methods, like counter conditioning, easier. So many people think it's just going to zonk their dog out.

Chris and Mike said...

#3 and #6 for me. Adding #7: Finding a vet who is trained in behavioral issues - they're not common in rural areas.

Our family is very drug-resistant; we don't even like taking aspirin, so we just knew we could train our highly reactive border collie out of her issues. Not.

A bit of a long story here, which may help some of your readers. After doing lots of homework, and having had well-trained cattle dogs all our lives, we adopted Habi from the shelter at age three, with great plans for life with an smart, high-energy dog. We quickly realized she was out of control, enrolled her in an obedience class, and trained, trained, trained, while giving her lots of off-leash exercise. She quickly lost one off-leash privilege after another, though, until she was restricted to our back yard, as her on-leash behavior was spectacularly horrible. We felt like total failures.

Three months along, she spent a week with our instructor, who on our return told us she was "far beyond the bell curve for a border collie", and gave us the phone number of a behavioral vet, saying "she's expecting your call".

After a thorough workup, Habi started on Prozac, and we simultaneously started a vigorous behavioral modification course. After a year, and progress from 'horrible' to 'manageable', we gradually withdrew the Prozac to see if she could hold her own without drugs, while continuing intense training/behavioral modification. She did hold her own - barely, with a lot of help, but we were so determined (again) to make it work we were somewhat blind to her struggles.

Finally accepting that she had plateaued, we re-started the Prozac last spring (two years later). There was no magic change, but in our fourth year together we are now (sometimes) able to loose-leash walk(!) on a flat collar(!) in our neighborhood(!) and ride fairly comfortably(!) in her crate in the car. Because we can now get out and about without being highly stressed, she's getting exposed to novel situations and lots of healthy stimulation, and the positive changes are snowballing. Because of the two-year Prozac hiatus, I'm pretty confident that the changes this year are because of going back on meds.
We have finally accepted that Habi's brain can't produce enough serotonin on its own to keep her stable, and that's not her fault, nor ours.

Most dogs can learn civilized behavior through training, and that would always be my first choice. But, for us it initially was a choice between meds and euthanasia, and then between meds and Habi living with the stress of constant high anxiety. We're comfortable with our decision for this dog in this situation.

By the way, she's been worth every bit of effort we've put in!

Crystal Thompson said...

I am very fortunate to live in an area with a board-certified vet behaviorist, but also one who is studying to become one. In addition, we have several vets who aren't certified, but have behavior practices.

For people in rural areas, this is much more difficult. Generally speaking, any vet should be able to call the closest local vet beh for a consult. There are also some vet behs that do internet/fax consultations. I believe Tufts does this. I'll have to do a bit of research and then update my links section with what I find out. :)

Anonymous said...

I am not against behavioral medication for dogs, but I've had a very bad experience with them. My vet (not a behavioral expert) had me put my dog on Clomipramine an anti-anxiety drug. Danny was very people friendly, but not dog friendly. While on the drug he bit a person.
Later, after taking him off that drug, I found that lessoning of inhibitions is a comman effect of the drug. I wish my vet had referred me to a specialist, so I knew what to expect.

Crystal Thompson said...

Oh, Anonymous. I am so sorry you had that experience. Behavioral medications are very, very helpful, but they do have downsides. The disinhibition you mention is one of them. My dog also experienced some of that in the first few months of medication. Thankfully, I knew what to expect AND had a trainer that could help us through it.

This is why I'm such a huge proponent of using veterinary behaviorists whenever possible. Unfortunately, there aren't that many of them in the US (and I have no idea what it's like outside the US).

I don't think you were wrong, incidentally. You sought out answers from a professional. It is unfortunate he/she didn't advise you better.

I hope things are going better for you and Danny... and that Danny's bite incident didn't get you guys in trouble/set things back too far.

Christine Lopez said...

Our dog Penny has been on both citalopram and clonidine since March 2013. Her story is a long one, full of behavior and medical issues, almost from the first day we adopted her in July 2012. I still struggle with the decision to put her on anxiety meds, but there is no doubt in my mind that she needs them. She is dog reactive, people reactive, thunder-phobic and has separation anxiety. There is one piece of advice that I want to pass along to everyone dealing with a dog that has any kind of issues, whether it is behavioral or medical....VIDEO, VIDEO, VIDEO! I can't tell you how many times this has come in handy. Before we met with our behavior vet, I posted many videos online so that she could see what we were dealing with. Trainers have viewed my videos, as have her regular vets and internal medicine vets. We were able to capture her hyper vigilance, reaction to dogs, anxiety, retching, etc., on video. One more thing, please do not hesitate to do a full medical workup. Don't blow off symptoms just because you can't get a straight answer. We have spent the last 21 months whittling away at Penny's medical problems, to include recurrent UTIs because of a recessed vulva (leading to vulvoplasty); inflammatory bowel disease; low cortisol; severe allergy to several environmental and food items, including the mites that live in dry kibble; non-existent B12 absorption and potentially some gastro sphincter issues, causing regurgitation. We are still working with her internal medicine vet to figure things out. But, the bottom line is, run the tests, keep Googling your questions, talk to the vets, and most important, TAKE VIDEO so that your vets and trainers have specific information that you really cannot capture just by describing it during the vet or training visit.