Is there a Place for Medication in Behaviour Modification?
I am changing tack here from my recent posts and putting on my behaviourist hat, to address something which I think there is a lot of misunderstanding around: Medication and behaviour. There seem to be two extreme views, one being that dogs should never be medicated to address behaviour problems (medication is a cop-out) and the other view that certain “medications” (I use quotation marks, as I include various supplements and forms of “self” medication in this statement) can cure everything and should be dished out like smarties.
Firstly, it is important to note that behaviour practitioners are not vets – we do not prescribe medication ourselves. However, part of our qualifications include (or should include!) training in psychopharmacology by specialist vets, so that we are in a position to identify situations where pharmacological intervention is likely to be helpful or even necessary and so that we have sufficient understanding to be able to then discuss medication options with the client’s vet and work with them in cases where medication may be a very helpful part of a behaviour modification plan.
So, why is medication ever really necessary? Well, let’s have a look at why one would use medication or what one would use it for:
Medication that is used to address behaviour problems tends to fall into two main categories:
Anti-anxiety medication and Anti-depressants.
These are medications that one would commonly refer to as tranquilisers and which are usually from a class of drugs called benzodiazepines. These drugs have an inhibitory effect on circuits in the brain which are involved in the fear response. They act relatively quickly (20-30 minutes) to reduce feelings of anxiety and fear, so are commonly used to alleviate the impact of frightening events such as thunderstorms, fireworks and car trips (for dogs that are fearful in the car). These drugs also have an effect on memory, so they interfere with learning (some even have a retroactive effect), so can be extremely useful during or even after traumatic events to prevent fear-conditioning from taking place.
These would be drugs such as TCA’s, MAOI’s or SSRI’s, which in a nutshell increase levels of serotonin to stabilise and boost mood. A common one in veterinary medicine is Clomicalm, which is usually prescribed for separation related distress, because it also reduces feelings of panic brought on by social isolation. The important thing to understand with any of this class of drugs, is that they take several weeks to change chemical levels in the brain, they need to be taken for several months and must be tapered off gradually when withdrawn.
So, when and how does one decide if medication is actually necessary? Well, we would look at the dog’s emotional state during a problem behaviour and their general everyday mood and try and determine the following:
1. Is the dog’s emotional state during a problem situation so extreme that it interferes with the dog learning any new or more helpful behaviour?
2. Can the problem situation be avoided or managed to avoid the emotional reaction and reduce stress?
3. Is the dog’s general mood such that the dog is capable of engaging and learning?
4. Are there environmental changes that can be made to reduce stress and increase enjoyment to boost mood?
5. Is the dog’s mood improving with positive environmental changes?
In other words, in terms of considering an anxiolytic, we would firstly look at how we can manage the environment to prevent the traumatic or fear-inducing situation. For example, if a dog was afraid of car travel, could we stop car travel temporarily and look at a long-term plan to use DS and CC around the car? In such a case, we could avoid medication, if we could control and manage the scary stimulus. However, if the dog’s extreme and debilitating emotional reaction occurs in an unavoidable situation, e.g. the dog is shaking, salivating and unable to find any comfort or acceptable coping strategy during a thunderstorm, appropriate anxiolytic medication would provide relief and prevent suffering during an unavoidable situation. Denying this relief would be unnecessary cruelty.
In terms of considering anti-depressants, if a dog were disengaged, shut down, lacked appetite and was generally depressed, one would first look at whether there were reasons for this which could be addressed. If the dog were lonely, bored, being regularly punished i.e. the dog basically had no life or was experiencing severe stress, then changing the dog’s circumstances could certainly change how the dog feels. But what if one did make suitable environmental and lifestyle changes and the dog felt no better? Consider the person who suffers from depression: there may be very real causes for depression in someone’s life and making changes or the healing of time may alleviate that depression. However, in some cases, there may be internal physiological factors that are causing depression and no amount of lifestyle changes will improve matters. Just as you would not criticise someone for taking medication to alleviate debilitating depression, we should not frown upon giving medication to a dog that is suffering in this way. In such cases medication can be a vital step in recovery and in giving a behaviour modification plan a chance.
So, when is medication really not advisable?
It is not advisable as a replacement for improving a dog’s lifestyle – if a dog is miserable, stressed or anxious because of very real circumstances, those circumstances need to be managed and altered, prior to considering medication or in conjunction with medication. Medication is not a replacement for giving a dog a good life.
Medication is not advised without a proper behavioural consultation having taken place (by a qualified behaviourist). One of the most common reasons people want to use medication is to treat aggression. However, while fear-motivated aggression can sometimes be improved by relieving anxiety or boosting mood and certain frustration-related types of aggression may be linked to low serotonin levels, it has to be kept in mind that anti-anxiety and antidepressant drugs tend to cause “disinhibition”, which means that dogs can be less inhibited in their responses. This reduced inhibition can lead to dogs using a more serious agonistic display when they feel threatened. If you want to understand disinhibition, think about a drunk person doing things they would not normally have the courage to do or the reported suicides “caused” by certain anti-depressants. Furthermore, if aggression has been used for a while as a strategy to cope with a situation and it has become a well-learned behaviour, improving the dog’s brain chemistry can actually make the behaviour even more reinforcing.
Medication should not be self-prescribed. While it is pretty obvious that we should not be sharing our medications with our dogs, borrowing medication from others or sourcing it on the black market, unfortunately there are “medications” which are unregulated, but “legal”. While most supplements may at worst do absolutely nothing, a very powerful drug is now available everywhere: CBD oil or Cannabidiol. While CBD oil does not have psychoactive properties that give one a “high”, it acts on CB1 receptors in the brain, which “deal with coordination and movement, pain, emotions, and mood, thinking, appetite, and memories, and other functions.” https://www.medicalnewstoday.com/articles/317221.php
“Epidiolex” is one of the only forms of CBD oil that is regulated and FDA approved (for the treatment of epilepsy). Clinical trials revealed the following side-effects for this drug:
• liver problems
• symptoms related to the central nervous system, such as irritability and lethargy
• reduced appetite
• gastrointestinal problems
• reduced urination
• breathing problems
The information leaflet also mentions a risk of worsening depression or suicidal thoughts. And recommends monitoring anyone using this drug for signs of mood change.
Yet, thousands of people are giving unregulated forms of this drug to their dogs at the drop of a hat with NO veterinary supervision at all. Facebook is littered with posts by people seeking help for their dogs for everything from itchy skin to dogs fighting in the home and again and again CBD oil is recommended as the cure-all. But just like any other drug, it may not always be appropriate, and it may have side effects which your vet needs to monitor. It is foolish to “self-diagnose” and “self-medicate”.
One more caveat is needed in regard to medication and behaviour: Antipsychotics are NOT appropriate drugs for behaviour modification. Drugs such as Acepromazine or Chlorpromazine have been used in the past (and sadly still today by those who don’t know better) to “tranquilise” dogs during veterinary/husbandry procedures or for grooming. I have even heard of people giving it to their dogs during thunderstorms. This is a drug that reduces dopamine levels and is used in humans to treat psychotic disorders such as schizophrenia (Thorazine). Dopamine is the chemical in your brain involved in alertness, movement and experiencing reinforcement. High doses of these drugs will inhibit movement and may make a dog appear calm and drugged. However, the horror of these drugs is that they do not alter the fear response and will result in an animal that cannot move, but is still awake, absolutely terrified and unable to do anything about it. “Drugging” dogs in this manner in frightening situations can result in dreadful long term consequences, including the development of serious aggression. Drugs such as these should only ever be used by vets as part of a cocktail of pre-op medication, where other drugs that reduce fear or render the animal unconscious are also administered.
This article is a very brief overview of how medication may be used in behaviour modification. There are other types of medication that have not been mentioned (such as those used to treat Canine Cognitive dysfunction) and even in the classes of drugs I have mentioned, there are many options, all with slightly different effects that are more applicable in certain situations than others. The take home message is that medication does have a place in behaviour modification and behaviour consultants should have a thorough understanding of how it can be used. It should not be viewed as a quick fix or a “go-to” strategy, but it may be extremely helpful to improve a dog’s emotional state or general mood, to facilitate learning and improve quality of life. Behavioural medication is best used with collaboration between your vet and a qualified behaviourist, so that the behavioural and physiological effects can be monitored closely.