Medications and Supplements

Medications and/or natural supplements can and even should be used in some cases when working with separation anxiety afflicted dogs. Not every dog with separation anxiety needs to be medicated. But in many cases, particularly more severe ones, the owners should seek veterinary counsel about medical options. I feel all owners should at least notify their veterinarian that their dog is experiencing separation anxiety and keep him or her in the loop.

Please note that in the discussion of the five phases of the separation anxiety treatment protocol that follows beginning in Chapter 10, I do not make medication and supplement recommendations. As mentioned before, that needs to be done by the owner’s veterinarian. As a trainer however, you need to understand the use of the drugs and supplements and to know what your clients are getting from their veterinarians. Besides, many veterinarians want to know what type of treatment you’re pursuing and aim to prescribe medication accordingly, so open communication between trainer and vet is always helpful—so in such circumstances it’s good to be familiar with the basic medical options.

When to recommend contacting a vet about medication

Medication is warranted in a variety of separation anxiety cases, and while it’s not your job to prescribe, you can educate your clients about medications as an option and why/when contacting their vet about medications may be useful. Dogs who are unable to settle even when the owner is home need medication, period. If the dog exhibits anxiety-related symptoms such as excessive hyper-vigilance about even the slightest movements of family members, pacing even when the family is relaxing, whining when one family member exits the room or house, and general anxiety display at all times even when owners are present then this is a dog that cannot settle. It is in clear contrast to a normal dog’s state of being when in his most comfortable state. So whether it is a hyper Border Collie or a sedentary Greyhound, what needs to be gauged is whether or not the dog can calm down completely within his breed temperament range without displaying anxiety about being left alone by his owners even when others are present. Additionally, dogs who continue to struggle through the first few weeks of the most minuscule desensitization efforts warrant medication consideration as well, as a way to gain purchase on the problem. Some clients resist the very notion of using medication. To be able to discuss these concerns with your client, you need a basic understanding of the medications used for separation anxiety.

Medications used to treat separation anxiety

Typically, the medications involved are antidepressants. Two medications have been labeled and approved for specific use with separation anxiety: Clomicalm® and Reconcile®. Both medications have been studied for a long time and are also used in human pharmacology.

The things your clients need to know about these two commonly prescribed separation anxiety medications include:

• They are not habit forming.
• They are not sedatives.
• They are not new; they are heavily researched and are safe to use.
• They won’t change a dog’s personality except to reduce overall anxiety, which may mean the dog becomes even more fabulous than he already is.
• They will likely not have to be permanent as many dogs can be weaned off or put on a reduced dose once the problem has been resolved.
• They aren’t prescribed because an owner is lazy and doesn’t want to do the work. On the contrary, they support a proper treatment protocol.

Clomicalm

Clomicalm was the first of the two medications to be approved for use in dogs with separation anxiety. It’s a tricyclic antidepressant, and it has been shown to decrease anxiety and support a sound behavioral protocol. Tricyclic antidepressants increase levels of norepinephrine and serotonin, two neurotransmitters, and block the action of acetylcholine, another neurotransmitter. For some dogs, Clomicalm is just the bit of help needed to further a behavior plan and resolve the problem successfully.

After the separation anxiety has been relieved, the medication can be weaned off in most cases. The generic version of Clomicalm is called clomipramine. Clomicalm is often the first medication veterinarians choose when asked about separation anxiety, most likely because it has been around the longest.

As with most medications, Clomicalm has side effects. The most common side effects listed by Novartis, the company that produces the medication, are lethargy, vomiting and elevation in liver enzymes. The lethargy, if it occurs, tends to go away after the first week or two in my experience. I haven’t personally seen vomiting to be that common, but I know liver enzyme elevation can be of concern and, for that reason, many veterinarians require occasional blood tests to make sure the dog isn’t at risk.

Reconcile

Reconcile was approved by the FDA for use with separation anxiety more recently than Clomicalm. It’s an SSRI (selective serotonin reuptake inhibitor) whose common name is Prozac® and generic name is fluoxetine. SSRIs like Prozac work by blocking the site where serotonin would normally get whisked away, which allows the serotonin to hang around a little longer. Serotonin is a chemical messenger, and higher levels of it in the brain are associated with mood stabilization which is why SSRIs are such effective antidepressants. In the studies done by the company that produces Reconcile, significant improvement was seen in dogs who took the drug in addition to following a behavior modification program versus those who did only behavior modification (42% showed signs of improvement versus 18%). The research further shows that within eight weeks, 73% of dogs treated with Reconcile showed significant improvement as compared to 51% treated by behavior modification alone (Elanco Market Reseach with Veterinarians and Veterinary Technicians, 2006).

These numbers support the remarkable effects I have seen personally over many years. Reconcile is also a very safe medication with low toxicity, making it an incredible breakthrough in the options available for dogs who suffer greatly.

The side effect most commonly seen with Reconcile is reduced appetite, but this often goes away within the first few weeks of treatment.

Other options

While Clomicalm and Reconcile are the most common antidepressants and the only ones labeled approved for use in dogs, a few others in the antidepressant category have also been effective. Most notably buspirone (Buspar®), paroxetine (Paxil®), sertraline (Zoloft®) and amitryptaline (Elavil®) can also be used.

Mild sedatives

Occasionally, veterinarians recommend that a sedative be used in conjunction with the antidepressant at the outset of the program. Most antidepressants take a few weeks to get into a dog’s system (what is known as the “therapeutic level”), and it’s during these early weeks that some veterinarians suggest the use of a sedative.

The sedatives are typically from a class of medication called benzodiazepines, or benzos for short. Medications like alprazolam (Xanax®), diazepam (Valium®) and clonazepam (Klonopin®) have different effects in terms of quickness of response and the amount of time they stay in the dog’s system, a variable referred to as the drug’s “half-life.” Sedatives wouldn’t typically be for permanent use because of their potential habit-forming properties and, well, sedative effect.

Unfortunately, many dogs experience a paradoxical effect with the use of some sedatives. Instead of relaxing the dog, the drug has the opposite effect and increases anxiety. Consequently, the use of sedatives should be monitored very closely to make sure they aren’t doing more harm than good. Note: Rarely will sedatives need to be used for owners who are suspending all absences with their dogs during a treatment program.

Acepromazine

This is a medication that is sometimes prescribed by veterinarians as a sedative for separation anxiety. I cannot caution you enough about its use. I call this medication a “chemical straight-jacket” because it incapacitates the body while leaving the mind totally intact and fully able to panic. In some cases it even heightens the senses, causing noise sensitivity, which is very prevalent (actually highly co-morbid) in separation anxiety dogs. This medication, while actually giving the appearance of a calmer dog due to the extreme physical sedation, can potentially sensitize a dog and worsen separation anxiety. It is still prescribed by some old school vets and some newer vets who feel pressured to help the desperate owner, but it is not a help, it is a potential hindrance.

Beta blockers

While not commonly used, beta blockers can be used with separation anxiety dogs with some success. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. When you take beta blockers, the heart beats more slowly and with less force. This slower heart rate has shown to help with relaxation and is one of the reasons that stage performers are fond of their use. They are noted to be quite safe if administered in the proper dosage. The most common beta blocker that I have seen prescribed is propranolol (Inderal®).

Clonidine

Some new medications have shown outstanding success. They may not be widely known or used by all veterinarians, but are definitely worth mentioning. Dr. Nicholas Dodman has successfully used one such medication, Clonidine, at Tufts University. Clonidine is a blood pressure medication that lowers the heart rate and thus helps affect relaxation. A few of the dogs I’m currently treating are taking this medication and I’m pleased to see its effectiveness. This is another medication for which I hope to see more research. Its effect in separation anxiety dogs could prove remarkable, particularly when other drugs have been unsuccessful for that particular dog.

Natural/holistic remedies and supplements

Your very best resource for natural/holistic remedies is a holistic veterinarian. He or she will be able to determine the proper combinations and dosages for the dog. One thing to note about natural and/or holistic treatments: while I have been fortunate enough to see some dogs get relief when treated holistically by a veterinarian, I have also seen clients become discouraged because they used up valuable time and resources with remedies that turned out to be ineffective for their dogs instead of starting with proven pharmaceuticals. As a trainer, it’s important to be aware that this is a highly personal choice and one you should respect, whichever way your clients lean.

L-theanine is an amino acid commonly found in tea (mostly green tea). It has been widely studied and is used to reduce mental and physical stress and to improve attention and mood. It is sold for use in dogs and cats under the brand name Anxitane®, which can be purchased online. L-theanine is also available in chewable treats and liquid drops. L-theanine has been used for humans for a long time and can be purchased at vitamin stores.

L-theanine can be ordered from www.swansonvitamin.com for great quality and prices. It can also be found at most vitamin and health food suppliers. Lactium is harder find, so Swanson is a good resource. It is listed as their Women’s Anti-Stress Formula.

Alpha-casozepine (Zylkene®/lactium) is derived from a protein in cow’s milk. In preliminary studies, it has shown some promise in the reduction of fear and anxiety in dogs. One study states that alpha-casozepine is as beneficial as using a benzodiazepine (such as Valium), but without the side effects of disinhibition often associated with the use of benzos. This is an interesting possibility that I myself have yet to see be effective, but as with a few of the other natural remedies, I find this a safe alternative and worth trying if interested. I have heard from other trainers that its effectiveness is as high as claimed, so I will continue to observe its use with my clients. I look forward to more studies of this supplement, but at this point in time, based on the results I have personally seen, I equate its use to drinking a glass of warm milk before bedtime.

Melatonin is a sleep hormone that affects the sleep-wake cycle. Many dogs do experience some relief of anxiety with the use of melatonin. However, it’s quite possible they get this benefit simply because the melatonin makes them a bit more tired. According to Dr. Dodman, melatonin is entirely safe to use. In lab studies it was shown that no amount of melatonin could be given that produced toxicity or overdose.

Rescue Remedy and other such homeopathic products are intended to improve the emotional state of the dog using very small dilutions of plant essences. According to Rescue Remedy’s website, the theory behind these plant essences is that ailing symptoms can be cured by a product that would produce the same behavioral or physical symptoms in a healthy individual. They state: Like cures like. No scientific evidence supports claims of value for these types of products, but the extreme dilution of the ingredients renders them harmless. Rescue Remedy in particular is a very popular product in human and animal use, and many claim to have received great benefit from it. I haven’t witnessed any such benefit in my clients and would say homeopathic products like this fall into the category of “can’t hurt and might help.”

Pulsatilla falls into the same category as Rescue Remedy, as it is another homeopathic remedy whose basis is “like cures like.” It deserves a special mention here because it has received a fair amount of discussion on some of my online groups as being quite successful in helping relieve separation anxiety symptoms. I am impressed at the number of separation anxiety sufferers who have claimed to have had favorable results using this remedy, and I am always hopeful to get such results with clients who want to pursue homeopathy. Additional herbal medicines that have some favorable results mentioned regularly are skullcap and valerian. As always, your holistic veterinarian is your best resource.

DAP® (Adaptil®) stands for dog-appeasing pheromones. Pheromones are natural chemicals that can act outside of the body of the secreting individual and impact the behavior of the receiving individual. In the DAP product, the chemical is a synthetic version of a hormone produced by nursing canine mothers intended to promote calm, secure behavior. For this reason, the product claims to be useful in dogs afflicted with separation anxiety. A few studies show that DAP has reduced anxiety in puppies in a statistically significant way. One particular study by Gaultier et al. in 2005 compared 30 separation anxiety dogs given DAP to 27 separation anxiety dogs given Clomicalm, and both improved equally. For the most part, my clients haven’t reported such benefits to me from the use of DAP, but a small percentage did have impressive results.

Because DAP has been effective in a handful of cases, I do recommend at least trying the spray version (which is the cheapest). I have a bottle of the spray that I bring to my initial consult and I spray the dog’s bedding and surrounding areas to see if we might see the dog relax at all. If we do, I then recommend the clients try the diffuser. Another one for the “can’t hurt and might help” category.

The Adaptil plugin is a great way to go, however the spray is the cheapest version and it also comes in a collar.

Words of caution

Just because something is over-the-counter, holistic or natural doesn’t make it effective or safe. Very few controlled studies exist to confirm the efficacy of common herbal remedies in pets, and owners are often swayed by their desire to believe anecdotal “evidence” they may hear from friends or online that has not been subject to scientific research. The same might be said for many drugs used in behavior therapy, but at least most have been proven extensively in studies of humans. Another problem with herbal remedies is that there can be considerable variation in purity and quality from one manufacturer to the next, and even from one batch to the next.

As a trainer, you need to educate yourself about the products your clients are considering using. Many natural products are sold on the Internet where regulations are lax or nonexistent. As an example, I have found several websites advertising stress relief remedies for dogs that contain a tiny amount of minimally active ingredients combined with fillers, alcohol and verifiable junk. At best, these remedies could be a waste of the owner’s money; at worst, a dog could have a bad reaction to the fillers and the alcohol. So proceed with care and make certain that scientific evidence and testing have shown the product to be useful and safe for dogs.

Other products to consider

A few other anti-anxiety products and treatments are worth mentioning in terms of use in a separation anxiety treatment plan:

• ThunderShirt. The ThunderShirt is a unique tool that can be useful for some separation anxiety dogs. ThunderShirt’s patented design applies a gentle, constant pressure that is supposed to have a calming effect for dogs. The important thing to understand about the ThunderShirt is that if it does give a calming effect for the dog, it can’t be something that is placed on the dog exclusively for absence times as it will simply become another departure cue. Dogs need to be desensitized to the ThunderShirt to make sure they are comfortable in it and that they are deriving benefit from it. The ThunderShirt is widely available at many pet stores, but also can be found at thundershirt.com.
• ThunderCap. The ThunderCap is not likely to be a useful tool for most separation anxiety dogs, but is worth mentioning for those dogs who need some reduction of “visual stimulation” during training. It looks similar to a horse’s fly cap; it fits over the dog’s head and is made of a mesh that the dog can see through. The ThunderCap should not be used for long durations. You can view or purchase the ThunderCap at thundershirt.com.
• TTouch Massage. TTouch, or Tellington Touch, massage and is an excellent way to help dogs get into a state of relaxation. Using TTouch is one way to promote both physical and mental calmness in any dog who experiences anxiety. The techniques used for this type of massage are available to learn through books, DVDs and online videos on sites like You-Tube. You can use massage to help an anxious dog get into a relaxed state prior to doing absence rehearsals, but it would be recommended that you do massage at other times as well so that the massage does not become a precursor to absences. To order books or DVDs go to dogwise.com.
• Anxiety Wrap. Anxiety wraps work much like the Thunder-Shirt by applying pressure at certain points to promote relaxation. There are many ways of doing an anxiety wrap, and examples of how to create your own abound on the Internet. Everything from complicated bandages going in many different directions down to a simply tied tightly fitting t-shirt can be used. Like with the other products mentioned here, anxiety wraps need to be used at times other than just when absences are occurring to eliminate the potential for it tipping off absences.
• Through a Dog’s Ear. These are music CDs that are intended to help dogs settle and relax. Developed on the principles of psychoacoustics, these CDs have very specific music on them that is rhythmically arranged to have the most effective calming results. I have been surprised to see the effectiveness of the music in many of my cases. The CD is available for purchase at throughadogsear.com.