Ask The Vet - What is the best medication for a dog with anxiety

What is the best medication for a dog with significant anxiety?

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Great question! First, a reminder that this column aims to provide general medical information and not specific information or advice for a particular animal. Now get your best “back to school” outfit ready and put your thinking cap on for a crash course and brief introduction into behavioral medicine.

Who’s who and some important terms in dog and cat behavior

Here are some quick definitions to provide some background

Veterinarian: A **rockstar** doctor that can legally both: 1) diagnose a behavioral condition in a patient based upon the patient history, physical examination, and diagnostics (think bloodwork), if indicated and; 2) prescribe medications, if indicated.

Veterinary behaviorist: A veterinarian who has completed extensive specific training, including a multi-year residency, and passed an advanced examination within the field of veterinary behavior.

Dog trainer: While anyone may refer to themselves as a dog trainer, there are those with advanced training and certification. An excellent trainer is pivotal to helping guide and execute a treatment plan.

Sedative: A medication that results in “sleepiness” and, as such, is referred to as being “sedating”.

Anxiolytic: Very simply, a medication that reduces anxiety. (in Latin, “anxio-“ = anxiety; “lytic-“ = destruction, disruption)

(Other terms you may hear are “tranquilizers,” and “antidepressants”.)

Sometimes, the goal of medicating an animal is to provide some level of sedation, but often we want a medication that is more anxiolytic and minimally sedating. This type of medication  would ideally remove the animal’s anxiety without making them sleepy so that they could still go about their day, just more happily.

Now to some specific medications!

There are two broad “classes” of behavioral medications.

“Background” medications

These medications are those that are taken on a daily basis to reduce the “background noise” if you will. They aim to lower the threshold for the anxiety, aggression, or other behavior being addressed. I think of them as taking it down a notch so that the animal can better think and re-learn/work through the behavioral concerns. Some examples of these are SSRIs (selective serotonin reuptake inhibitors) and TCAs (tricyclic antidepressants). Fluoxetine, or Prozac, is a commonly used SSRI. They are all slightly different and if one does not work well, another might be tried.

“Situational” medications

This group of medications is given as needed (think before a scary thunderstorm or a stressful car ride). They are sometimes used in conjunction with a “background” medication depending on the need. They are fast-acting but do not last for a long period of time (i.e. less than 24 hours). However, they can greatly facilitate behavioral modification and training efforts so that long term positive benefit can be achieved. Some commonly used medications include trazodone, Xanax (alprazolam; and other benzodiazepines), gabapentin, Sileo (dexmedetomidine in an oromucosal gel), and acepromazine (when used with other medications; alone, it does not reduce anxiety but is rather just a sedative).

(FYI: “Doggy Xanax” is a term I often hear. Usually, it’s the same Xanax, or alprazolam, that is prescribed to people. Remember, though, that each animal metabolizes medications differently. What is a safe dose or drug in one species may not be in another—always consult your veterinarian first!

Also, behavioral medications are often used “off label” as a specific study(ies) has(have) not been performed to support its use for that specific condition.)

Nutraceuticals

Nutraceuticals, those substances that include herbal supplements, vitamins, minerals, etc. abound with claims for efficacy for many positive health benefits, including anxiety reduction. Certainly there are excellent nutraceuticals that are helpful, but remember to always think and learn critically. Ask your veterinarian for specific advice, read scientific papers and literature where available, and call companies/manufacturers directly to ensure product quality. Remember that, given the lack of robust regulations of non-pharmaceuticals, t many products may not contain what they claim to. Some substances with the potential to reduce anxiety/other behavior concerns include omega 3s, CBD oil, melatonin, and certain probiotic strains.

Behavioral Modification

This is beyond the scope of this article, but remember that usually the goal of behavioral medications is to aid in and facilitate behavioral modification and training. Usually, a behavioral ailment is not simply fixed by giving a medication, but rather a “multimodal approach” is taken to address the problem, in which many approaches are provided systematically together.

So, what is the answer to your question?

Ultimately, it completely depends on the specifics of the anxiety. Anxiety may be a result of pain that needs addressing. It may be due to a condition such as hypothyroidism (low thyroid functioning). It may be a defined behavioral disorder. (Note that as we learn more and more about other non-human animals, our ability to diagnose and define specific behavioral disorders and pathologies grows. We know that non-human animals such as dogs suffer from many of the disorders we do, and our knowledge continues to grow.)

Ultimately, if medications are considered medically warranted, the goal is never to change your dog, cat, or other animal so that they are not themselves. One size doesn’t fit all. If one medication doesn’t work, there are others that can be tried.

And remember, always reach out to your veterinarian (who will know their limits in when to refer to a veterinary behaviorist and/or ask for the support of a dog trainer) or a reputable dog trainer (who will appropriately know their limits to what they can provide and what needs the assistance of a veterinarian).

With peace,

Dr. Emily

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Disclaimer: The content of The Bethel Grapevine’s Ask the Vet blog is for informational purposes only. It is not intended as medical advice and should not be treated as such. If you have a medical question about your pet, call or visit your veterinarian or a veterinary hospital.