Anti-anxiety medications, sedatives, atypical antipsychotics and tranquilizers have all been used to treat emotional disorders in companion animals. The dosages listed here are a combination of those published and those used in clinical practice. Dosages of drugs used in veterinary behavior change as studies are produced and empirical information is obtained. It is recommended that before prescribing a medication, veterinarians research the current dosage and side effects.

Few pharmacokinetics studies are available in dogs and cats for the medications discussed here. Most drugs used in veterinary behavioral medicine target stress, impulsivity and arousal which are at the root of many behavior problems. Still other drugs are used for sedation. In order to understand the use of medication in the treatment of behavior problems, the clinician should have a basic understanding of the neurobiology of fear and anxiety. The noradrenergic system, dopaminergic system, serotonergic system, GABA-ergic system and the sympathetic nervous system are all involved in the stress response.

The medications discussed here can be very helpful in the treatment of behavior cases in dogs and cats, but they should not be prescribed without a treatment plan including safety recommendations, behavior modification and environmental modification. These elements are required to meet the standard of care, for a positive long-term outcome and allow the pet to eventually be weaned off of the medication at some point in the future.

When deciding to institute pharmacologic therapy, the veterinary should consider 7 questions:

1.  Is the environment conducive to a positive outcome?

2.  What is the animal’s latency to arousal?

3.  Is the animal’s quality of life affected?

4.  Is the animal at risk?

5.  Is the behavior predictable?

6.  What is the severity of the behavior?

7.  What is the recovery time?

While it is impossible to predict how diligently a particular client will implement the behavior modification and management changes, certain factors can be considered when assessing the adequacy of a particular environment. The presence of young children, the number of caretakers in the house, the number of hours that the dog has to be left alone during the day and the owner’s willingness to participate are all factors which will affect outcome. The best ways to assess these factors are to take an accurate history and have an honest conversation with the owner. If the household is clearly deficit in the qualities needed for a positive outcome, a pharmaceutical product should be strongly considered as a part of the treatment plan.

The latency to arousal is the amount of time that it takes for gross signs of the stress response to be able to be observed. For example, a dog who reacts with a stress response to the barometric pressure has a short latency to arousal. Dogs with a short latency to arousal should be considered candidates for treatment with at least one pharmaceutical.

Emotional disorders can significantly affect an animal’s quality of life. Daily panic attacks contribute to chronic stress which can cause various sequelae as noted above. If the animal’s stress reaction is intense on a daily basis, a pharmaceutical should be considered as a part of the treatment plan.

The assessment of risk to the patient is dependent on owner attitude toward the patient and the problem as well as the strength of the human-animal bond. If the owner is considering euthanasia or if the pet is causing injury to herself, a pharmaceutical should be considered for the patient.

The veterinarian should consider the severity of the problem. If the problem is moderate or severe, the patient should be considered for pharmaceutical intervention.

Finally, the veterinarian should consider if the behavior is predictable. If the behavior is not predictable, the patient may be in need of a pharmaceutical.

The chart below is a general guideline for prescribing decisions. For certain cases where the risk is great enough to outweigh all other parameters, the veterinarian may decide to prescribe a medication as a part of treatment. In other cases, patients may have multiple “yes” answers in the prescribe column and the veterinarian may choose behavior modification only.

There are four possible outcomes when considering the seven questions above:

1.  No medication

2.  Primary medication

3.  PRN medication

4.  PRN and primary medication.

Once the veterinarian has determined based on the questions above that the patient does in fact need a medication or supplement to improve significantly, the question becomes which medication to choose. First, make a diagnosis. The diagnosis will generally point you to a class of drugs. For example, if you diagnose a patient with generalized anxiety and fear, you will be led to the antidepressant category. From there, you will have to decide which drug class with in the antidepressant category would be best for this particular dog. Consider first the dog’s affect. Is the dog very kinetic and frenetic in its manifestation of fear? Which your transmitters might be at the root of this dog’s behavior disorder? Serotonin and norepinephrine are both involved in fear and anxiety. In addition, norepinephrine can affect energy level. What effect do you want from the medication? Do you want it to slow the dog down, speed the dog up, or simply relieve the fear without any alteration of the dogs affect beyond that?

In the case above, you may decide to use Clomicalm® because it also blocks the H1 histamine receptor and will cause fairly quick slight sedation giving the owner some relief while you wait four to six weeks for the full effect to become apparent on the dogs primary disorder of fear. If the dog’s affect is more flat, but not depressed, you may choose one of the selective serotonin reuptake inhibitors.

If the dog is apathetic and curled up in the corner of the room, unable to even walk outside to a eliminate without fear you may choose to use a selective serotonin reuptake inhibitor and a benzodiazepine to elevate mood quickly so that the dog can have improvement in her quality of life before the time that it takes for the selective serotonin reuptake inhibitor to work. Keep in mind that there are many combinations. There isn’t one perfect medication for each diagnosis.

A full blood panel including a urinalysis and a thyroid hormone assessment as well as a physical examination should be done on all animals to be treated with medication. Patients treated with dietary supplements or a change in diet should still have a complete physical exam, however, there isn’t a need for lab work unless there is another circumstance which leads the veterinarian to believe that laboratory testing would be proper.