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7500 Old Oak Blvd., Cleveland, OH 44130. Your questions will be answered by Dr. Overall in upcoming columns.
Karen L. Overall
This column is the first in a series addressing the most-common questions that veterinarians ask me about behavioral medicine.
Some of the questions are:
- What drug do you use for condition X?
- How long do we have to treat the dog with medication?
- Can we stop it abruptly?
Once veterinarians are comfortable with these issues, they usually are more willing to use medication as part of a treatment
regimen for troubled patients, and can intervene before the condition worsens.
Like most endeavors, one must gain experience with behavioral medication to become adept in its use, paying attention to outcomes
What drug do you use for condition X?
This query is one of my least favorites, because it implies a simplistic and "quick-fix" approach to behavioral medicine.
We live in a world of highly engineered medications that can have very specific uses, but for many disciplines, including
behavioral medicine, the pharmaceutical approach is still relatively nonspecific.
Additionally, molecular biology and genetics have opened a new world for the understanding of disease processes. Sometimes,
this new knowledge changes our entire perception of diagnosis and treatment.
Nowhere is this more obvious than for retroviral diseases and medications to treat them.
I suspect that, in 20 years, the way we now treat behavioral problems will seem as if we approached them with a shotgun.
That said, our approach today is more nuanced and specific than when I started in this field. At that time, the solution was
to use tranquilizers for virtually everything. Simply sedate the pet so it wouldn't exhibit the problematic behavior.
The problem with that approach is that it puts a damper on normal and desirable behaviors. No dog or cat treated competently
and appropriately with currently available behavioral medications should be or feel drugged.
We don't have a drug for every condition because many involve non-specific signs (e.g., barking) that rely on activation of
various regions of the brain and various neurochemical systems that are affected both by environmental inputs (e.g., how threatened
does the dog feel?) and the true underlying pathology at the molecular level.
However, we can pick medications based on the behavioral patterns the dog is exhibiting, combined with understanding how these
medications are thought to work.
Just how these medications work often is logical and simple enough that veterinarians can explain the process to their clients
in practical terms. That will encourage clients to comply with the overall behavioral-treatment plan, bringing a high rate
Commonly used drugs/medications
Most of the medications prescribed for treating behavioral problems in pets fall into one of a few classes:
- benzodiazepines (BZs)
- tricyclic antidepressants (TCAs)
- selective serotonin reuptake inhibitors (SSRIs)
- combination TCAs/SSRIs
- some newer antipsychotic agents and atypical anticonvulsants.
These compounds all act by altering levels of neurotransmitters in certain regions of the brain. They do this either by affecting
activity at a neuronal receptor, or by changing the neuron's activity or metabolism by directly altering internal chemistry,
or by some combination of actions.