Finding the Right Fit: Types of Behavior Medications That May Help Your Dog or Cat
The choice to start any behavior medication for your dog or cat is a big one. It includes weighing the risks and benefits, understanding the cost, adjusting your routine, learning to administer them, and discussing options and following up with your veterinarian. Behavior medications can provide a huge benefit to your pet, especially if they are struggling to cope with daily or infrequent life events. The world can be exciting and fun, but some of our pets may see it as unpredictable and stressful.
Medications can help your pet cope. Allowing them to remain stressed can have consequences to their mental and physical health, your household dynamics, and ultimately, their quality of life. Luckily, we don’t have to let them suffer. There are a wide array of medication options that may be a good fit for your pet.
Below is a summary of the four types of available behavior medications, including their description, general mechanism of action (how they work), and how they are often used. Understanding the different types can help you have a conversation with your veterinarian about your questions, concerns, or observations.
Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Antagonist/Reuptake Inhibitors (SARI)
How does it work?
SSRIs like fluoxetine (aka Prozac® aka Reconcile®) are a class of antidepressant medications that work by preventing the reabsorption of serotonin in the brain. By preventing the reuptake of serotonin, the concentration of circulating serotonin increases, thereby enhancing its effects on mood, anxiety, and behavior.
SARIs like trazodone block serotonin receptors to prevent the reabsorption of serotonin. This increases the circulating concentration of serotonin in the brain, leading to less anxiety.
When do we use them?
SSRIs are a common first-line treatment in veterinary behavior modification. It’s often used for separation anxiety, generalized anxiety, fearful behaviors, obsessive-compulsive behaviors, and inappropriate elimination.
SARIs are used for managing short-term anxiety associated with specific events like veterinary visits, travel, confinement during recovery, or noise phobias (e.g., thunderstorms, fireworks).
How long to see full effects?
SSRIs require up to 8 weeks to get the full effect of the medication, although response to therapy can be seen sooner. A taper is recommended to avoid side effects including vomiting and tremors.
SARIs can be used daily long-term or on an as-needed basis, with effects typically being observed within one to two hours for short-term relief.
What are possible side effects?
Common side effects of these drug types can include decreased energy levels, vomiting, diarrhea, tremors, restlessness, and excessive vocalization. A decrease in appetite and sedation are typically short-lived. Seizures were reported in 0.4%–2.5% of dogs treated with fluoxetine.
Tricyclic Antidepressants (TCAs)
How does it work?
TCAs like amitriptyline are a class of antidepressants that work by blocking the reuptake of both serotonin and norepinephrine (NE) and increasing the circulating concentration of both molecules. TCAs address the fight-or-flight response.
When do we use them?
In veterinary medicine, TCAs are used to treat separation anxiety, anxiety-related aggression, inappropriate urination, obsessive-compulsive behaviors as well as neuropathic pain and itching.
How long to see full effects?
Like SSRIs, they have a delayed onset of clinical benefit. It can take several weeks to see an effect, and requires a taper if stopping it.
What are possible side effects?
Side effects can include sedation, constipation or urine retention, and rarely, hyperexcitability or seizures.
Monoamine Oxidase Inhibitors (MAOIs)
How does it work?
MAOIs like selegiline (Anipryl®) are a class of medications that block the enzyme monoamine oxidase. This enzyme is normally responsible for breaking down dopamine. By preventing this breakdown, MAOIs increase the concentration of circulating dopamine which improves mood, attention, and provides mild pain relief.
When do we use them?
Selegiline is the only FDA-approved medication specifically for the treatment of Canine Cognitive Dysfunction (CCD), also known as dementia. The medication is used to help manage the symptoms of CCD and may help slow the progression of the disease. Like the other class of drugs, the effect of selegiline may take up to 8 weeks to become apparent.
How long to see full effects?
You should see effects by 8 weeks and may see continued improvement up to 12 weeks. A taper is recommended to stop this medication, especially after long term use.
What are possible side effects?
Due to potential drug interactions, it should be used with caution when given concurrently with other medications that increase serotonin levels, such as trazodone or clomipramine, as this can increase the risk of adverse effects. Common side effects noted can include vomiting, diarrhea, restlessness, disorientation, or lack of appetite.
Norepinephrine Attenuators / Alpha-Adrenergic Agonists and Antagonists
How does it work?
This category includes medications that change the effects of norepinephrine (NE), a key neurotransmitter in the fight-or-flight response. This class includes situational medications including clonidine, dexmedetomidine (Sileo®), detomidine (Dormosedan®), and prazosin.
Propranolol falls into this class as a beta-blocker, by blocking beta receptors in the heart and blood vessels resulting in a decreased heart rate and blood pressure.
When do we use them?
The dampening effects of this class of drugs is meaningful for patients with excessive stress response, as it can reduce anxiety or aggression and constant vigilance.
Propranolol, typically used to treat abnormal heart rhythms and high blood pressure in dogs and cats, can be used to address panic.
How long to see full effects?
Effects of these classes of drugs are observed within 30-60 minutes. No taper is required to stop these medications.
What are possible side effects?
Side effects of clonidine can include vomiting on an empty stomach, and cardiovascular changes (eg. blood pressure, heart rate) if given injectably.
Prazosin side effects seem rare, but can include decreased energy levels and an upset stomach.
Dexmedetomidine (Sileo®) and detomidine (Dormosedan®) can cause changes to blood pressure, heart rate, and body temperature.
Propranolol, because its primary use is to treat heart rate and blood pressure, can cause changes to both of these. Passing out and diarrhea in dogs and vomiting in cats has also been reported with this class of drugs (beta blockers).
Other Medications — Anxiolytics, Sedatives, and Pain Medications
Anxiolytics
Gabapentin and pregabalin target specific channels in the nervous system, which reduces pain signals. This class of drugs are commonly used to treat chronic neuropathic pain and as an adjunct for anxiety, phobias, and panic disorders, especially when administered 90 minutes before a stressful event like a vet visit.
Sedatives
Acepromazine is a tranquilizer and sedative that works primarily by inhibiting dopamine and other receptors, commonly administered for infrequent anxiety episodes. However, it can occasionally induce the opposite effect including excitation or aggression in some dogs.
Pain medications
It’s important to keep in mind that pets with underlying pain need to be treated directly with effective pain relief, while simultaneously addressing behavior modifications. Anxiety, stress, and unwanted or concerning behaviors are unlikely to reduce or cease if the underlying cause is not addressed.
Helping Your Pet Cope
Many veterinarians, like Dr. Stephanie, take a special interest and focus their continuing education around certain topics such as behavior modification and medications. These veterinarians may be comfortable helping you and your pet navigate behavioral challenges. You can always consider adding a board-certified veterinary behaviorist, a Diplomate of the American College of Veterinary Behaviorists (DACVB), to your team if things get complicated or your pet needs special attention.
If you are interested in discussing behavior medication to help your pet cope, you can schedule an initial virtual consultation. If you are located in NYC, our Fearful Pet Care Package may be a great option for your pet’s veterinary care while working through behavior challenges or concerns.
