I have used behavior modification techniques in combination with veterinarian prescribed medicines since the year 2000. When I started this combination treatment, the use of drugs was mostly considered “extra-label”, meaning the use was different than the drug’s labeling yet met the standards that veterinarians were required to follow. Drugs are usually used for cases involving more noticeable and intolerable levels of anxiety, fearfulness, repetitive behaviors, aggression, and a handful of other behavioral disturbances. Typical drugs used are Trazodone, Fluoxetine, Clomipramine, Gabapentin, Acepromazine, Alprazolam, Clonidine, Buspirone, Venlafaxine. There are more exotic drug treatments that have also been tried, and are possibly used, in various cases.
I had researched the use of these drugs by studying books and articles by veterinarians. Back then, the monthly cost was prohibitive for many dog owners. A monthly dose of Fluoxetine (Prozac) for typical Labrador Retriever was about $110 a month. Veterinarians were hesitant to prescribe these drugs unless and until it was a last resort for these dogs. I think the breakthrough was when the FDA approved the use of Clomipramine HCL (under the label of “Clomicalm”). Prior to that, veterinarians were more commonly, and more comfortably, using Acepromazine for behavioral issues. I remember speaking with a vet in Mercer Island who told me he preferred using Acepromazine over all other behavioral medications. I have some experience with several of the above-mentioned drugs and other drugs, but not all. The more exotic treatments typically have only been mentioned in behavioral studies and would not be known to most veterinarians.
I will say I had some good success using the combination of behavioral modification techniques in conjunction with the veterinarian prescribed drugs. I only saw one adverse behavioral reaction to a particular drug, which would be referred to as a “paradoxical reaction”, where the dog became strange and more defensive. This anxious dog became scary to the owners. I quickly had the owners get the dog off that drug. I also evaluated dogs already on certain drugs, such as benzodiazepines. Today, when I evaluate dogs with behavioral issues, I always ask if the dogs are on, or have been on, any of these drugs. Sometimes the drugs can fool unsuspecting people and make dogs especially dangerous to be around. The drugs can also pollute the evaluations, since they interfere with observing the underlying issues going on. There was a dog in rescue a few years ago that almost killed someone that was on one of these drugs. The dog was deteriorating in rescue, the dog was put on such a drug as a solution, and the dog eventually tore into this person and caused life altering injuries. There is no drug that can fix canine PTSD, and when a dog is developing, or has a full-blown case, of PTSD, no drug is going to be the answer. The drug is only going to temporarily mask the danger until it is too late. I can’t prove it, but I think the use of the drug played a role in this incident.
All drugs have potentially dangerous side effects, and thus, I don’t recommend them as regularly as I did when I started out. I have found I can get good results without the drugs. Some side effects can be medically risky and should be monitored with regular blood draws. Some drugs are known to be hard on the kidneys, liver, or other organs. If a dog is on one of these drugs, I always recommend that the owners get regular blood draws as needed. However, this advice is sometimes dismissed, even by the prescribing veterinarians. Sometimes I recommend that the owner discuss switching drugs or weaning their dogs off the drugs. Some veterinarians will disagree, and I must work with that even when I think the outcome might not be what the owner wants. Some side effects can be behavioral, and some drugs can make the situations worse. Sometimes a drug can work to help overcome one issue but increase the potential for the exhibition of other behavioral issues. Sometimes, the drugs are like giving dogs water… no noticeable effects, good or bad, at all.
After all these years of experience, I have developed little confidence in the effectiveness of using these drugs relative to just the proper application of behavior modification techniques. I think in some cases, where it might be the difference between a dog living or dying, I might suggest that the owner discuss this route with their veterinarian or a certified behavioral veterinarian. I have found, for the most part, that with sufficient time and diligent application of proper techniques, that the drugs are unnecessary. I also think that these drugs are overprescribed and too much reliance is given to what a drug might do, and too little effort is applied in developing new responses and skills for the dog and owner.
I also think that the willy-nilly application of these drugs in dog rescue is dangerous. I don’t think that dogs in shelters or foster homes should be regularly medicated with these drugs. I believe that some people have been seriously injured because people don’t know what they are doing. I also don’t have much confidence in many of the drugs that are available over the counter. So-called “natural” remedies, while legal, are risky and generally untested in any rigorous way. For example, it is not unusual to hear about people online recommending CBD (or other herbal preparations) for behavioral issues. I’m not comfortable with that at all. Things like this should be done only with the consent and monitoring of a qualified veterinarian.
Part of the problem here is that veterinarians aren’t really qualified to give behavioral advice but are legally allowed to prescribe behavioral medicine. This includes what I’ve seen from the handful of certified veterinarian animal behaviorists. I think there is too much focus on giving a dog a pill, and not enough experience or knowledge with training dogs to do anything. I don’t think you learn a lot about your craft by staying in your office, examining the dog in your office, and then administering a prescription. Unless you are out there daily, hands on, working with these dogs in their homes and in public, most of what you know is just theoretical and hearsay from the owner.
So, at least for me, after about a decade of experience, I went back to just using behavioral modification techniques on almost all dogs. There will be some exceptions along the way, and usually I will refer people to their veterinarian, or in some cases, to a certified veterinary animal behaviorist. I need to know if there is an underlying medical reason as to why the dog isn’t acting normally. For example, I have spotted potential medical problems that were driving abnormal behaviors in dogs. These have been later verified by their veterinarians by causes, or contributing causes, such as: arthritis, pancreatitis, Addison’s disease, hyperthyroidism, cancer, potential exposure to illegal drugs (such as the French Bulldog that probably ate something like meth while on a walk along the Seattle water front), neoplastic bone development, deformed joints, infections, dislocated vertebrae, malformed spinal column that was pressing upon the spinal nerve, allergies, or past injuries. A lot of the non-medical causes have been from abuse, traumas, lack of socialization, neglect, improper training or no training, dog fights, or teasing. Behavior modification can’t fix medical problems, and those must be ruled out or treated for any training to matter. Sometimes you can fix the medical problem, and the behavioral problem goes away. Sometimes medical procedures are recommended by veterinarians that don’t fix the behavioral problem, such as routine recommendations to spay or neuter.
My experience says my way gets a more realistic view of the dog and owner relationship. You then must tease apart the knot in the dog’s brain, and often change what the owner does with the dog, to get to some kind of reasonable outcome. That takes time: sometimes days or weeks and sometimes months or years. Not all dog problems can be solved, and not all dogs can be made safe. Most of the time I have a plan for working with a dog, and in most of those cases, the dogs are made better over time. Sometimes I encounter dogs that I will refuse to work with. I did that recently. The dog was showing early signs of canine PTSD. I said the same to the owner. She found another trainer to work with. Hopefully it all works out. I must draw my own lines based upon years of my experience. I can be wrong, just like anyone. But if I was right in this recent case, someone or another dog could be seriously hurt. I feel bad for the dog and desperate owner, but I don’t regret what I recommended. It also isn’t the fun part of my job.
So, what should you do if your dog has a behavioral disturbance? That can’t be answered here. You must find some good and honest people to work with to pick apart the causes and then diligently apply reasonable steps. Such steps might involve the use of behavioral medicines. Feel free to discuss the options with your veterinarian, and get detailed written information on the risks, both medical and behavioral. Behavioral drugs can help in some cases, but I don’t think they should be the focus of the treatment.