In this episode, I talk with Dr. Amy Pike, DVM, DACVB and Dr. Amy Learn, both board-certified veterinary behaviorists and our topic is behavior medications for primary care veterinarians.
Some of the things that we discuss include common [behavior] dosages, potential mistakes to avoid and expertise from both doctors to help you in choosing the right medications to treat the target behavior.
Often access to a board-certified veterinary behaviorist can be a challenge for clients, especially if they are already paying for a trainer or behavior professional as well as your services. Having access to DACVBs for vet to vet consultations can be considerable assistance to you in deciding how to move forward with medical intervention on a behavior case.
The following is a checklist for important considerations prior to using a psychopharmaceutical with a patient. If you have any questions regarding any of the items listed, please feel free to drop your question in the comment section.
Starting Checklist For Pyschopharmaceuticals:
- Normal labwork (CBC, Chem, Urinalysis)?
- Concurrent medical disorders?
- Appropriate Diet?
- Pain score?
- Generalized or event-specific behavior?
- Appropriate behavior professional on board for b-mod?
- Breeding animal?
- Competition animal?
- Target neurotransmitters?
- Contraindications (pharmaceutical/medical)?
- Consulted a veterinary behaviorist?
The days of handling the job of multiple professionals as a single veterinarian are thankfully in the past. With the help of the right behavior professional to work through a behavior modification plan and the assistance of board-certified veterinary behaviorists, you can offer your clients a team approach in solving behavioral problems with their dog or cat.
With all of the information packed into this video, my greatest takeaway from my conversation with these two lovely ladies is that veterinary behaviorists are often underutilized and should not be the last resort but rather a first step in deciding the best course of action to help both your client and their beloved pet when considering behavior medications.
Some quick additional takeaways:
- Prozac is not a silver bullet for behavior problems and is not a PRN or BID drug (based on the half-life of the active metabolites)
- Drugs alone DO NOT solve behavior issues
- Gabapentin used for anxiety is dosed much higher than when used for pain (pain = 5-10mg/kg and anxiety = 20-50mg/kg)
- Unless symptoms specific to hypothyroidism are present, there’s no need to check the thyroid just for behavior-related problems
- Considering the target neurotransmitter coupled with the severity of symptoms should drive medication selection. For example, a dog who is shut down and unable to enjoy experiences may benefit from increasing dopamine (in addition to serotonin) which is our pleasure neurotransmitter with a starting dose of Sertraline at 1mg/kg BID. A dog that is impulsive and over-aroused may benefit from a starting dose of Venlafaxine at 1/2-1mg/kg BID. Venlafaxine regulates serotonin and norepinephrine and with a dog that is hyperaroused and impulsive, regulating norepinephrine (again, in addition to serotonin) can help those types of symptoms the best.
- Involve owners in the feedback cycle to determine the efficacy of treatment choice. You can use subjective scales (i.e. 1-10) during bi-weekly check-ins with clients, have clients drop off fecal samples for testing fecal cortisol levels, and ask them how their pet is responding to behavior modification with a professional.
- Be aware of seemingly benign ingredients that may be contraindicated in your patient, for example, maltodextrin in Zylkene capsules with diabetic patients.
Don’t be afraid to consider psychopharmaceuticals in young puppies where behavior may actually be cured versus if treated as an adult can only ever really be managed.
- Be aware of the risk for serotonin syndrome when coupling medications
- When switching medications, there may or may not need to be a significant washout period. For example, a direct switch may happen in going from one SSRI to another but when switching Fluoxetine to Selegiline, there needs to be a 5 week period in between the two drugs in the system.
- Use your PVPs!
- Post-COVID dogs are going to need extra support.
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