Knowing when to medicate: anxiety and your dog
Knowing when to visit the vet with your reactive dog is important. There can be many reasons behind barking and lunging. Those reasons can be a direct result of health issues. They may also be worsened by poor health. Helping your dog with behaviour is not simply for a dog trainer or behaviour consultant.
Anxiety or fearfulness is a common reason why dogs struggle with the world. This can obviously manifest as barking or lunging at people or at other dogs they see. Once you have ruled out the role that frustration and poor impulse control may be playing in your dog’s behaviour, it’s useful then to consider normal canine behaviours like territoriality.
You can download the Lighten Up Guide to Reactivity to help you understand the reasons behind barking and lunging.
It is important, however, to consider that there may be times when medication could definitely help. This is especially true of anxiety and fearfulness. Training is very useful for frustration, and ongoing support alongside training is helpful for impulse control issues, but medication can be part of best practice when it comes to helping our dogs live more joyful lives.
Concerns over medication
Many people are surprisingly resistant to medication for anxiety. Despite the fact that anti-depressants and anti-anxiety medications are frequently prescribed and very successful in treating human emotional disorders, having a dog ‘on Prozac’ is often faced with responses that suggest people find it about as desirable as behavioural euthanasia.
Indeed, I have known people who would rather euthanise an animal than give them a chance with anti-anxiety tablets.
Some of this comes from human concerns over ‘Big Pharma’. The Alternative Medicine lobby has some particularly powerful voices and champions who are ironically not expected to do anything as ‘Big Pharma’ as put their opinions and thoughts through rigorous and robust scientific research. Because such practitioners can make claims directly in public, they can quickly gain currency. Ironically, they often use the same advertising and marketing techniques as the companies they deride.
It can be very hard for us to analyse their claims, especially when they do not make their biases clear. In research, scientists have to declare any conflicting interests. In trial-by-social-media, less ethical individuals do not always declare their conflicting interests.
Sadly, criticism of evidence-based practice then affects our dogs. As a consequence, people tell themselves that vets are ‘Prozac pushers’ and that they have vested interests. In France, at least, vets who were found to recommend specific products could be struck off for anti-competitive practices.
It is not unusual, however, for people in France to speak as if the French veterinary population have paid courses from specific pharmaceutical or food companies. It’s very easy to listen to what happens in worst-case scenarios in the United States of America and assume they are global truths.
When science is held to account
Robust and rigorous science is held to account in a public fashion. Results are published and people’s careers can be ended if their results are shown to be wrong. Because of this, it can be easy for us to generalise. Science also has a primacy effect. Whatever is published first, even if it is later retracted, tends to be taken as accurate.
Thus, it’s easy for us to believe things to be true even when they’ve been disproven.
Robust research is also self-appraising. This is normal and people with strong scientific literacy appreciate this fact. We accept that findings are more nuanced from time to time, or that reports will be published which may contradict, modify or support initial research.
Because many of the behavioural medications we may be offered to our dogs have often been on the market for humans for a long time, we also appreciate their limitations. It’s not simply a case of ‘take two of these and call me in the morning’. This can make us skeptical of the impact of behaviour medications, especially if we doubt their success in human experience.
Also, when science does operate on the margins of acceptability, it also makes it hard for us to understand whether something is truly effective. It’s easy then to become very cynical about research and about its results. This is worsened in countries where insurance companies are regularly involved in veterinary healthcare and choices are made by them on an economic basis.
Healthy responses to medication
When our vet prescribes a medication with the information we have given them about our dog, it’s sensible to make clear observations of our dogs and to follow the vet’s guidance to the letter. Sometimes our dogs may have side-effects at the beginning of treatments. Rather than stopping medications, it’s important to have discussions with the vet.
When one of my dogs started on phenobarbital for seizures, he was very enervated and constantly hungry. It was heartbreaking. However, his symptoms settled down within weeks and my vet gave me advice on how to better manage his hunger. When he started having seizures again after 18 months and was diagnosed with refractory epilepsy, we added a new medication into his pharmaceutical regime.
The three months it took to find that medication were the hardest of my life with him. I really thought we’d reached the end. Discussing it with the vet and adding an additional medication brought us almost two more years of seizure-free life. Of course there were side-effects. Sometimes, these can be very serious. In those cases, the vet can help us consider what the best case scenario is.
It’s healthy to identify side-effects and discuss these with your vet. It’s healthy for us to understand where it will and will not work. It can also be very depressing to have statistics about success or failure, but they also help us realise medications are not a panacea.
Unhealthy responses to medication
It is unhealthy to assume that natural products are more beneficial for mental health issues and that all pharmaceuticals should be a last resort. Natural products can be very good, but they can also be of dubious quality, unregulated, pushed by people who are paid by heavily marketed and highly profitable alternative therapies companies.
In France, Ceva produce lots of ‘non-pharmaceutical’ products which have been tested against alternatives, and there is some degree of self-regulation that is very helpful. Other companies like them produce supplements that are often highly controlled and sometimes tested for efficacy. Many also produce licensed pharmaceuticals too.
Not all companies who produce supplements are created equal. Sadly, the ones who have the least oversight make the most noise. It’s always useful to check if there have been studies into supplements or alternative products, and to check the places in which these have been published.
Sadly, some people end up convinced by the alarming amount of misinformation that their dog would be better to trial a ‘natural’ product. This is true even when the supplement industry is unregulated, when their products are not controlled and when they have not been subjected to research.
Such products weaken our faith when they do not work. They can also be incredibly expensive. Because they have not been subjected to any kind of testing, if they occasionally work, then we are left not knowing why or how. This makes it tough to use those products with other dogs who may benefit.
The typical process where supplements fail
Many people with anxious dogs go through a surprisingly similar journey. First, they ask for advice on social media, and other people recommend a whole host of things. After this, they then trial the ones that most fit with their worldview. If they view vets as ‘Prozac Pushers’, then they’ll ignore people who say they should go to their vet. If they prefer ‘natural’ remedies, then they will be more likely to work through these.
And we all would prefer natural, wouldn’t we? This ‘appeal to nature’ fallacy can be very misleading when it comes to mental health. On the one hand, molecules in foxgloves gave us Digoxin to manage cardiac arrhythmia and molecules in aspirin were derived from the plant hormones in willow trees. On the other hand, cyanide and arsenic are also natural and not quite so good as cures for things.
Many people also hold off on medication because they see it as a last line. We can also view supplements with an eye that it could help and it won’t hurt. I’ve used that line myself!
Yet for dogs who are really struggling with anxiety, it can prolong poor welfare. If there are side-effects to chronic states of stress, then this too can worsen our dog’s physical and psychological health.
In holding off and delaying appropriate treatment, it can certainly cause harm to our dogs.
Other human processes relating to pharmaceuticals
It’s also unhealthy, however, to go into our vets expecting a miracle cure overnight.
We need to understand how pharmaceuticals work. Some medications will work in minutes, like Sileo for noise phobias. Others take weeks, like selective serotonin reuptake inhibitors (like fluoxetine). Our dog may need other medications alongside a primary medication, and combinations can be useful.
Getting it right will rarely happen overnight.
Pharmaceuticals can also suffer from social media popularity. Not all pharmaceuticals are available for licensed use in all countries, and may not be available more widely. Trazadone is one example. We can be seduced into thinking X or Y medication can help, because we read about it in a group on the internet, only to find out that it is not registered for use in our country or that our vet is unwilling to use it if they have not trialled other licensed drugs first.
Veterinary medicines are authorised for different uses in different regions depending on what assessment data has been taken into account when licensing them. Vets can go ‘off licence’ in restricted conditions and should follow a decision-making process outlined in their country. This will prioritise licensed medications in your country. They may also get a special import licence in some countries too – but this won’t necessarily be their first step.
It is really important that we understand how medications work. It’s not unusual to hear of people using medications wrongly and then being cross that they did not have the desired effect. In some cases, they can significantly worsen problems if used wrongly.
Does our dog need a pharmaceutical?
The only person who can answer this is a vet or behavioural veterinarian in discussion with us.
We can help them significantly in their decision by presenting information clearly. This can help them decide if our dog needs a situational medication for occasional use, such as with specific noise phobias. They may also decide that our dogs needs something more long-term that will alter the brain chemistry more slowly, such as with generalised anxiety, depression or social phobia.
They can only make an informed evaluation based off what we tell them about our dogs.
We can help by sharing a diary of behaviour we have noticed. It’s useful to note down any incidences of behaviour, what triggered them (if known) and how long the behaviour continued for. Making a note of the intensity of the behaviour and the things you notice can also help.
If our dogs are regularly anxious, we could note how many times they seem anxious in the day, what they do or any changes we’ve seen. We can note whether it’s affecting their social relationships with others or their general behaviour. In particular, if it alters their usual eating or elimination routine, noting that can also help.
It’s sometimes also useful to note things that they don’t do. For instance, a noise-sensitive dogs may react to thunder and fireworks, but not to gunshot or loud vehicles going past outside. We can also make a note of things they usually do that they don’t when they’re anxious, for example willingness to go on walks.
Normal or not?
Sometimes, it can be hard to know if our dogs are behaving like ordinary dogs. One dog I used to regularly walk was very nervous on walks and never sniffed or engaged with his environment. He was often anxious in new situations and it would take him a long time to get used to things.
Sometimes, it would take him days to settle in.
He didn’t have any specific phobias, but he certainly wasn’t a dog at ease with himself.
For this reason, it can be a good idea to get in touch with a behaviour consultant. When behaviour consultants have a background in ethology, they can help you document what your dog does. They can also help you understand whether behaviours are ordinary or not.
Some may ask that you visit a vet first, but if you explain that you would like them to help you document your dog’s behaviour in order to accurately report things to a vet, then they should be happy to help. They may give you a proviso that you see a vet as soon as possible, however. Particularly if it seems like your dog may have health issues affecting their behaviour, this is a wise precaution.
In this way, we can help our vets make the best decision about the path to support our dogs. Particularly if our dog is struggling with generalised anxiety, medication can be an excellent fit. It may take some time to get it right, but as long as we appreciate that fact, we will at least be able to make an informed decision.
If you are a professional regularly working with dogs who struggle with anxiety, you may find this 4-hour webinar series on conditioned safety cues to be of use.