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The Use of Medications in Canine Behavior Therapy

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The Use of Medications in Canine Behavior Therapy PEER REVIEWED ON YOUR BEST BEHAVIOR The Use of Medications in Q & A:Canine Behavior Therapy Ilana Reisner, DVM, PhD, Diplomate ACVB Reisner Veterinary Behavior & Consulting Services, Media, Pennsylvania our longtime client, Mrs. Jones, presents Addressing Client Buttercup, the Papillon, with “a behavior Reluctance Y problem”: For several months, Buttercup has If behavioral medication been biting houseguests. Through questioning and is indicated, but the client is reluctant, discuss- ing specific concerns educates the client about the observation, you determine that Buttercup is anxious. benefits of medication. Common concerns include: She was “shy” as a puppy, exhibits fearful postures 1. My pet’s much-loved personality will change. when unfamiliar people try to pet her, and—as a This is not the goal. The only personality charac- teristics targeted for change with drug therapy are home video of her behavior reveals—runs away from those associated with anxiety and reactivity, or guests trying to interact with her. such problems as repetitive (compulsive) behavior. Because psychopharmacology can have unexpect- ed effects—for example, one client reported that The presentation of behavior problems during routine her dog seemed less inclined to play with toys after appointments is one of the inevitabilities of today’s vet- administration of a drug—it is also important to erinary practice. Behavioral drugs can help manage reassure the client that his or her pet’s response will these problems—but not all drugs are equally useful, be monitored, and the medication effects can be and their use is not always indicated. The plot thickens reversed or limited by reducing the dose or switch- when some clients demand medication, while others re- ing to a different drug. fuse to use it despite veterinary recommendations (see 2. Drugs are unhealthy or unsafe. Addressing Client Reluctance). There are many behavioral drugs, and most are quite safe to use—even with chronic administra- WHY USE BEHAVIORAL tion—in healthy patients. Medication is prescribed only after a physical examination and, if the medica- MEDICATION? tion will be administered for a long period of time, Augmentation of Behavior Modification screening blood analysis should be performed. The treatment goal of any behavior problem is modi- This testing, including CBC, serum biochemistry fication of that behavior. However, the term behavior profile, and urinalysis, is recommended: modification is vague and depends upon the individu- • Annually for patients receiving behavior drugs for al patient and behavior being addressed. over 1 year Q1. Management of any problem behavior requires • Semiannually for patients over 8 years of age that recognizing and avoiding the stimuli that trigger the are receiving behavior drugs, or more frequently if behavior in question. there are concurrent medical issues of concern. 2. The dog needs to learn to behave differently in 3. My pet will be sleepy all the time. response to the stimulus. The term differently is Unless sedation is the goal, such as during thun- intentionally nonspecific because it is tailored to the derstorms for phobic dogs, nonsedating drugs individual animal and context in which the problem are used, so sleepiness should not be an issue. If behavior occurs. unexpected sedation is a side effect of behavioral Behavior modification might include anything from medication, the drug dose can be reduced or a dif- counter-conditioning a fearful dog; actively training an ferent medication can be prescribed. While it is not appropriate, alternative behavior to a cue; or desensitiz- uncommon for behavioral drugs to cause transient ing a separation–distress dog to its owner’s leaving the sedation initially, it can often be avoided by starting room. Thus, behavior modification can play an impor- with a lower dosage, then increasing it over several tant role in management of a problem behavior. weeks to the desired dose. tvpjournal.com July/August 2014 today’s veterinary Practice 63 | ON YOUR BEST BEHAVIOR Reduction of Stress In some cases, there are limits to how far behavior mod- Case Application: Buttercup ification alone can go. Extreme situational stress or fear In Buttercup’s case, the first step—avoid- can interfere with learning and decision making. ing the stimuli that trigger the behavior—might When dogs are overtly reactive—or, in the language simply mean keeping her in a separate area or of dog training, over threshold—they are physiologi- gated part of the house while Mrs. Jones en- cally aroused, which involves both the autonomic (fight tertains guests. or flight instinct) and endocrine (hypothalamic–pitu- The second step—learning to behave differ- itary–adrenal axis up-regulation) systems. In these cases, ently in response to these stimuli—can include: there is rarely any middle ground—the dog will move • Feeding Buttercup a high-value food while a rapidly from a lack of reaction to extreme avoidance, ag- guest is seated and in view (counter-conditioning) gression, or panic. • Asking her to lie down on a previously speci- Temperamental or inherited generalized anxiety can fied mat while the owner is entertaining (alter- also interfere with learning. Generalized anxiety, similar native behavior). to situational anxiety, is more pervasive and challenging to overcome through training alone. In these patients, the addition of behavioral drug learned tasks, successful desensitization, and/or therapy can significantly improve response to treatment. counter-conditioning, drug therapy may allow the When underlying anxiety is reduced, the dog is more owner to move further toward treatment goals. receptive to learning and its behavior can change more reliably in the long-term. As one owner of a fearfully aggressive dog reported after 2 months of fluoxetine ad- HOW SHOULD MEDICATION BE ministration, “I feel like it’s opened a door to her brain.” PRESCRIBED? Anxiety is an underlying component of many canine be- Sedation, If Needed havior problems (Table 1). Reducing this anxiety often Although, on a day-to-day basis, sedation is not a desir- improves the problem behavior directly or decreases able drug effect, it may be necessary to eliminate distress stress, raising the threshold for reactivity, fear respons- spikes in specific situations, most frequently: es, and other behaviors. • Separation anxiety (administered at point of the Before starting drug therapy in any animal, regardless of owner’s departure) Q age, physical health, or category of drug, a medical history • Thunderstorm or fireworks fear (administered just (including current medications) and physical examination before the event) are indicated, along with analysis of blood and urine. • Car or airplane travel (administered 30 minutes before travel; then repeated as needed during travel). Rather than administration on a daily or standing TABLE 1. Canine Behavior Problems basis, sedative medication can be given on an as-needed Associated with Underlying Anxiety basis, often in combination with a daily medication. • Aggression between household dogs • Compulsive disorder WHEN SHOULD BEHAVIORAL • Fear-related aggression • Fears/phobias MEDICATION BE PRESCRIBED? • Inappropriate attention-seeking behavior There is some flexibility with regard to prescribing medi- • Leash reactivity cation relative to the behavior modification plan. • Resource guarding • If drug therapy is unequivocally indicated (eg, • Separation anxiety severe separation anxiety or severe fear, including fear-aggressive behavior), ideally prescribe it during Qthe same appointment as the behavior assessment, Duration of Therapy which incorporates it into the entire behavior man- Duration of treatment with behavior medication agement plan. ranges from: • If the plan includes significant management • Relatively short-term (eg, 6 months for patients in changes that do not require medication and/or which anxiety must be reduced to allow learning to the pet is not impaired by stress (ie, pet has rea- occur) to sonably good quality of life at time of presentation), • Longer-term therapy (eg, years for animals whose consider delaying medication implementation until a behavior is not adequately responsive to behavior follow-up visit. In some cases, behavioral drugs may modification alone). be unnecessary. Other considerations include: • If a pet undergoing behavior modification has • Length of time for medication to take effect: reached a plateau with little advancement in Some medications (eg, antidepressants) require 1 to 2 64 today’s veterinary Practice July/August 2014 tvpjournal.com ON YOUR BEST BEHAVIOR | months for full effect, while others, such as benzodi- azepines and other sedatives, act more immediately. • Loading period: The initial loading period of TABLE 2. Common Medications Used for Ca- some drugs should be considered when planning nine Behavioral Problems therapy and duration of treatment. (Alpha Order by Class) Once it’s been determined that the patient’s response POTENTIAL to medication is adequate, a reasonable duration of ini- DRUG DOSE ADVERSE tial therapy would be at least 6 months, which allows EFFECTS a generous period of time for behavior modification Azapirone (learning). Buspirone 1–2 mg/kg PO Q • Aggression 8–24 H disinhibition Discontinuation (anecdotal) Abrupt discontinuation of medication may cause re- • Increased bound anxiety or exacerbate behavior problems. Any anxiety medication should be tapered gradually (weeks to months, depending on duration of therapy); a good guideline is a
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