By Christine D. Calder,
DVM, DACVB
Board-Certified Veterinary Behaviorist, www.caldervbs.com
When medication is recommended for a behavior problem, many caregivers hesitate. These are medications people recognize. Many have taken fluoxetine or something similar themselves, or know someone who has, and that experience comes into the exam room with them. The result is a set of very common questions and a few very common misunderstandings.
What do behavior medications actually do?
Behavior medications target EMOTIONAL STATES. They do not target personality.
The goal is not to change who your dog is. The goal is to change how your dog feels. We are working to reduce fear, reduce frustration, and reduce panic in situations your dog currently cannot cope with. The playful, affectionate dog you know does not disappear. In most cases, when the fear comes down, more of that dog is available to you, not less.
Will my dog be sedated?
Sedation is not the goal of a daily behavior medication. Some dogs are mildly sleepy during the first few days to a week, and this is usually short term. If your dog is still groggy beyond that point, the dose or the medication may not be the right fit and may need to be adjusted. This is also why these medications are often started at a low dose and increased slowly rather than started at the target dose.
A dog who appears flat, dull, or heavily sedated is not a dog on a working plan. Report this to your veterinarian.
Are these medications safe?
Many of these medications were developed for people. That does not mean their use in dogs is guesswork. There is a large body of research behind the medications used in veterinary behavior, including fluoxetine, clomipramine, venlafaxine, trazodone, and clonidine. Fluoxetine and clomipramine are FDA approved for use in dogs, as is dexmedetomidine gel for noise aversion. The others are used extra-label, which is common and accepted in veterinary medicine when the use is supported by evidence. The doses and dosing intervals come from that literature.
Most of these medications are also safe for long-term use, including use in dogs with other medical conditions. What is required is a physical exam and screening blood work before starting and recheck exams and blood work on a regular basis afterward.
Will medication fix the behavior?
No. Medication is one part of a treatment plan, not the whole treatment plan.
Behavior changes when three things happen together. Management reduces your dog's exposure to the triggers, which slows the progression of the behavior and stops your dog from rehearsing it every day. Training builds new foundational behaviors, and behavior modification teaches new coping skills and changes the underlying emotional response. Medication makes all of this possible.
Why is medication needed at all?
Because a dog who is fearful, frantic, or flooded with frustration cannot relax, focus, or learn. The thinking brain is not available. Medication increases learning potential, and learning is what changes behavior long term. Many caregivers have worked hard for months with no progress, and the problem was not effort. Their dog was not able to learn because emotion was blocking the learning process.
How quickly will it work?
That depends on which type of medication is being used, and there are two.
Event, or situational, medications are given ahead of a stressful event that can be predicted but not avoided: fireworks, thunderstorms, veterinary visits, grooming, car rides. These are usually given about thirty to ninety minutes beforehand and work that same day. At home trial doses can help determine which medication to use, the dose, when to give it, and whether there are any side effects.
Maintenance medications are given daily. These are for dogs whose triggers cannot be reliably identified, predicted, or avoided, and for dogs who are not improving with behavior modification alone. They take time. Some changes may be noticeable in two to three weeks, but full effect commonly takes six to eight weeks. Some dogs need both types.
Because of this timeline, plan on a real trial of about six months with checkpoints along the way. If nothing has changed by three to four weeks, the dose may be adjusted. If this adjustment does not help, a different medication may be considered. A dog should not be labeled a medication failure after only ten days.
Will my dog be on medication forever?
Not necessarily. Many dogs are eventually weaned off. The dogs most likely to come off are those whose caregivers followed through with management and behavior modification, and who stayed on the medication long enough for real change to occur. That usually means at least six months, sometimes a year, before weaning is discussed.
These medications are never stopped abruptly or on your own. Weaning is done gradually, generally by reducing the dose by about twenty-five percent every one to two weeks.
Some dogs do stay on medication for life. This is a good outcome, not a failure. When a dog has an ongoing, pathological reason for the behavior, long-term treatment is a welfare decision.
Is my dog too young?
There is no age limit. Puppies as young as twelve weeks have been started on medication when the situation warranted it, and there is nothing in the literature advising against it. Starting early can actually extend the window of neuroplasticity, giving a fearful puppy more opportunity to form positive associations, and the earlier medication is started, the better the chance of weaning later.
Who should be prescribing?
Your veterinarian. Prescribing requires an examination, a working diagnosis, and an understanding of how these medications work and what their potential adverse effects are. Trainers can be excellent partners in carrying out a behavior modification plan, but diagnosing a behavior problem and choosing a medication is veterinary medicine.
Waiting has a cost. Every week a fearful or reactive dog rehearses the behavior, that behavior becomes better established and harder to change. Dogs do not just get over it, and fear does not resolve on its own. If emotion is blocking your dog's ability to learn, medication can be part of the treatment, not a last resort.