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When do we use medication?

As discussed in previous resources, Behavior Therapy consists of 3 major categories: Management, Behavior modification, and Medication. In a perfect world, we use a combination of environmental management to set up our pets for success, ensure their stay under threshold, and then use behavior modification to flex the muscles of certain skills. There will, however, be animals (humans included!) who cannot be successful no matter how hard we try to control their world. No one wants to put their pets on medication, but sometimes it is necessary to ensure their ultimate happiness and quality of life. 

Think of it like this: you have a pet that starts urinating inside the house. You take them to the doctor for an examination. They start off with a urinalysis and find glucose (sugar) in the urine. A couple follow up tests later and we find the pet is diabetic. Your doctor walks you through your treatment options and you ultimately decide insulin and a prescription diet are warranted to treat the underlying condition and help them feel better. 

But you did everything right! You fed them a great diet, they exercise regularly, you use treats in moderation, why did this happen? Did I cause my dog to become diabetic?

Of course not. 

Some pets are genetically predisposed to developing certain medical conditions. Sometimes those genes are activated by certain environmental factors and the pet becomes ill with that disease. That doesn’t mean you made it happen. Sometimes… it just happens. 

The same is true for behavioral disorders. Despite doing everything right, some critters just come up with poor brain chemistry. This can manifest in a lot of different ways - fearfulness, anxiety, aggression, inability to settle, etc. Lifestyle is still extremely important, but sometimes these critters need medical support to help “supplement” those coping molecules, like serotonin and dopamine, just like that diabetic needs a supplement of insulin. 

So, how do we decide when a patient needs medication? Like anything else, there is no “one size fits all.” According to Behavior Problems of the Dog & Cat, there are four situations where medications might be indicated: 

Adjunct to behavior therapy

Essentially, the medication is prescribed to help speed along the training process. Most pets with behavior problems are highly intelligent, but their worries get in the way of the learning process. With the use of medication, we reduce those fears and allow the learning process to take place. 

Drug desensitization

Medications are used to essentially eliminate the stress response surrounding a certain context or stimulus. Once the stress is eliminated, the pet then learns they can stay calm in this situation. Over time, the amount of medication is gradually reduced, while still allowing the learner to remain relaxed. This is a common situation with separation anxiety. If the family cannot discontinue departures, we use a combination of short acting medications to manage the condition. Over time, many pets learn that departures can be tolerated and they no longer need such dramatic amounts of medication. 

With compulsive disorders, like this 6 month old Bull Terrier's Shadow Chasing (pouncing), medication will likely be primary mode of treatment.

Primary mode of treatment

Some behavior problems have a very strong biological component. These conditions are unlikely to resolve with just behavior modification. Examples of this might be compulsive disorders or very early onset of aggression. 

Underlying pathology present

Finally, there are some behavior disorders that result from an underlying neurologic malfunction. These conditions occur because the brain does not create enough calming or coping neurotransmitters or they create an overabundance of reactive and stimulating neurotransmitters. In these cases, the main issue is medical, not just behavioral. Examples might be generalized anxiety or compulsive disorders. 

These are the “Textbook” reasons why medication might be warranted. Living in the real world, however, the lines can be blurred and there are far more practical reasons medication might be warranted: 

  • Inability to manage the environment. 

    • Ideally, the perception of the stimulus should be diminished enough that exposure to it will not result in an immediate response. This isn’t always possible. 

      • Ex: Leash reactivity when living in the city. 

  • Cannot use learned behaviors in practical situations.

    • The animal can learn new skills and use them in or around the home, but in the face of their triggers, regardless of how far away they are, the learned cannot effectively use those behaviors to cope. 

      • Ex: Fearful at the vet.

  • The behavior is impacting quality of life

    • Treating behavior problems also encompasses the family. If the family is feeling dejected, unmotivated, and/or overwhelmed, they can’t help their pet. Using medication can provide some immediate relief, allowing the family more mental capacity for the behavior modification. 

      • Ex: Highly aroused or “high energy” animals. 

  • There are safety concerns

    • When dealing with dramatic aggression or even just large animals around frail humans, using medication helps dampen the intensity of their behaviors, making it safer for them to be around. 

      • Ex: Rambunctious, large puppy around elderly family members. 

  • It would help speed up the learning process

    • Many behavior problems can be treated with just behavior modification, but it makes life much easier for the family and pet when using medication in combination with your training program. 

      • Ex: Separation anxiety training. Can take 6 months without medication or 2 months with medication. 

It’s always hard when people ask “If it were your dog, what would you do?” That’s a loaded question. My life is not your life and my worries are not your worries. I have years of experience and education allowing me to feel confident in troubleshooting any issues that arise, but I also have very low tolerance for behavior problems in my own home. I wouldn’t have gotten another pet in the first place - I have a small home, a special needs cat, two rambunctious little boys, and I already work way too much. I don’t have time for another pet.

As medical providers, our role is to give you options. We can talk about theoreticals and maybes and ifs until we’re blue in the face, but we never really know how an animal responds to therapy. We’ll do our best to give you common scenarios, but there are no guarantees. As this pet’s care giving, you need to decide what makes the most sense for you. That might mean that you want to jump on the medication bandwagon right out of the gate, you will absolutely never use medication, or you might be somewhere in the middle. There are a lot of reasons why we might use medication to help behavior problems, what are yours?

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