Meds for anxiety

DukesMom

Yesterday Duke had a vet appt for some eye discharge (turned out to be nothing). As per usual, he was a neurotic mess during the exam...panting, whining, shaking, tail down, eyes fearful, doing everything to get AWAY from the vet and student (we go to the UW Vet Med Hospital). No amount of treats or positive reinforcement has helped at the vet. (Although he has had double TPLO surgeries and follow-up rehab at this same hospital...so perhaps he associates with that.) He is also a mess in the car, although this seems to be anxiety rooted more in excitement than in fear. Certain sounds really bother him (but oddly, fireworks/thunderstorms don't bother him a bit!). He has no separation anxiety to speak of. He is also never destructive of things or himself.

Duke is just an exceptionally nervous dog in general. Emotions, in particular, really set him off. If, for example, I'm on the phone and start laughing loudly...he gets that "nervous" look and heads away from me. I've learned to go in another room and put him on a down/stay in his bed to avoid this stress for him. I have a friend whose son is mentally ill and he avoids this kid like the plague--I believe he senses instability. He is very noise reactive--most sounds concern him and he's a very light sleeper because of that. I don't play T.V. (which I rarely watch, anyway) or radios loudly, except for classical piano because it's very soothing to Duke. But...I can't play piano CD's 24/7!

I rescued Duke at 4 mos old and he is now almost 7. He has come a LONG way. He used to pant, whine and pace all the time, never letting me out of his sight. I've done obedience training with him with the goal not of having a "perfect" dog, but of helping him gain confidence. I have an amazing relationship with this dog--unlike any I've ever had before. He trusts and relies on me completely. I have tried D.A.P. and its effects are mild. The "Calming Cap" someone suggested is ludicrous! He hated it. We've been to a behaviorist twice now. While the advice helped greatly, the techniques did not result in alleviation of his extreme anxiety.

So yesterday, the vet suggested meds such as clomipramine or fluoxetine. I'm familiar with both and understand exactly their affect on chemical imbalances in the brain.

My question isn't a technical one...it's an ethical one. FOR THOSE OF YOU WHO ARE OR HAVE MEDICATED, when did you finally decide to go forward with it? I'm almost feeling guilty for considering it. I don't want to medicate Duke as an "easy way out," yet I want him to have the best quality of life possible. I've done a lot of behavioral/confidence building work with him and will continue to do so. Now I wonder if meds could supplement that.

I don't post a ton here...but I have lurked for some time and I know how heated certain topics can be. I hope this isn't one of them! I'm not looking for information on research or opinions on herbals or debates over training techniques. Just looking for feedback from those who have personally made the decision to medicate.

Cracker

Cracker is on clomipramine (clomicalm) for her SA and generalized anxiety. I did behaviour mod first for months and had success, then a change in her home environment sent her back into a spin. This is when her anxiety started to generalize. The turning point for me was when after another attempt at desens. she started to vomit and lose weight. I could SEE her spine. I took her to the vet, had her weighed and she'd lost five pounds that she didn't have to lose. We immediately discussed the pharma options and decided on clomipramine. Combined with the CC and training/beh mod she is greatly improved.
I WILL try to wean her off in the spring, but if it doesn't work I will happily continue with the meds, being careful to keep an eye on her organ function tests etc. Her quality of life is much more important to me than anyone else's ideas of whether drugs are appropriate for our dogs.

DukesMom

Thanks. My hesitation is because Duke does NOT have issues like Cracker's...he doesn't vomit or lose weight (although if he's stressed out I have to be near him before he'll eat). In some situations he is just fine--and in others he's an anxiety-ridden train-wreck.

His bloodwork and urine testing came back all normal, so he's OK to start the meds. I may give it a try, just to see if it helps him...I don't know.

ruckusluvr

Ruckus is on Amitriptlyne for a chemical imbalance and aggression.
before meds this poor guy never wagged his tail. now he is a new dog.

railNtrailcowgrl

I decided to medicate (for SA) when my dog broke off a canine tooth, broke a toe, and bloodied her nose to the point that people though I abused her, she was causing so much self mutilation we had to try something else because behavior modification was not enough on its own.

After much deliberation and not many other options (to the point she was so miserable I was considering euthinasia) my vet and I decided to try Chlomicalm. The medication along with a very strict and heavy behavior modification/desensitization program, took off enough of the edge off her anxiety that I could acctually TEACH her something and she was LEARNING. Pebble had VERY sever SA, she started the CC near the end of November '08 and was completly weaned off by the first week in April '09. She would have been off sooner however the vet wanted her off the meds before her spay and that sent her into a complete tailspin so we continued a "mini" course of CC to help her regain more stability.

Don't feel guilty for what others think or say about you decision to medicate. It is a tool just like anyother training technique and in some cases there are very valid reasons for medicating a dog.

Lwood

My Maddy (Rottie mix) is on Reconcile for anxiety. She has always been an anxious dog but after we lost our older dog and then got a puppy this past summer, she started to react to strangers and kids in ways that really bothered me (and could have been dangerous, she chased and growled, etc.) Being on the Reconcile has allowed me to work more effectively with her and to recharge the NILIF as well as more socialization but I still see things that worry me. She chased a young boy in the nearby park about a month ago and scared the hell out of him and his parents (and me). I understand all the reasons and the psychology behind it but I can't stand the idea that she might aggress and hurt someone because of a treatable condition. I know the vet does not want her on it forever. (She is 2 1/2) and I agree and understand that but I always want her to be comfortable and safe.

By the way, I have a daughter who is on meds for ADHD and have faced the same kind of worry about judgment that you are feeling. My daughter's quality of life, our family life and her education have all improved 100% since we made that hard decision and I do not regret it for a minute.

Cracker

Duke,
I have a question..what sort of protocol did you do for positive reinforcement for the vet's office? Desensitization after trauma (the surgeries) requires a very very consistent classical conditioning, not just lots of cookies to try to make it a happy thing.
He may be so over threshold that the rewards are not good enough to affect change. Will he TAKE food when he's there?

Regardless, I think meds make a huge difference in enabling a dog's anxiety levels to drop enough to allow the CC to work. Cracker couldn't LEARN to be alone because her panic was at such a level she wouldn't eat (situational anorexia)...the meds don't cure the anxiety per se, they lower the stress hormones/reaction to the point that behaviour mod CAN be effectively applied. When the learning has occured, in many cases (but not all) they can be reduced or stopped altogether.

I'm going to throw out a couple of suggestions here:
Teach a "go to your mat" behaviour, where you teach him to go and lay on his mat using REALLY GOOD STUFF, and then massage him to get him to relax on the mat. Work on this enough and then you can take the mat with you to the vet or in the car or whatever and transfer the behaviour to there. There is a good explanation of this kind of work in the book "Control Unleashed" by Leslie McDevitt. The book is aimed at people who do agility with anxious and reactive dogs but all of the exercises are perfectly suited to the everyday world..they teach a dog an on and off switch, relaxation poses etc.

Check out www.fearfuldogs.com for good explanations of CC and how to properly apply it under threshold.

Look into an anxiety wrap for Duke..it's like "swaddling" a baby, and can often reduce anxiety due to the acupressure points the wrap hits. I've used this for Cracker in severe thunderstorms. You can use it to help him become accustomed to sounds and your friend's kid.

Buy some CD's of sounds that your dog finds scary and gradually desensitize him at home to them.

All of these things CAN work if applied well. I certainly do think that Duke may do well on meds to get his levels down so you can do the work needed. You've obviously come a long way already so good work!

DukesMom

Well, I just did the same old, same old...treats and reassurance. I honestly don’t know WHAT to do. I could give him ace, but I just cannot do it. I don’t like the side-effects and risks involved. The vet hospital is great, they are so good to Duke, but he still associates it with scariness.

He will sometimes take treats during the examination, but he takes them VERY roughly. Or he'll take the treat and then spit it out. In the lobby he's a lot better and will even sit/lie down for treats.

The car is another place where I’m just at a loss. He has no trouble when the car is idling—it’s when we’re driving. And it doesn’t appear to be motion sickness, either, because he never gets sick or “looks” sick. (He has an “I’m about to barf” look that I know well, and I never see that look in the car.) His car reactivity is to fluctuations in speed, going over bumps, changes in scenery…all things you cannot avoid. I’ve tried treats, D.A.P., stuffed Kongs, bones, the Calming Cap and acoustically pleasing music (low volume/tempo classical piano). None of it works in the car.

The only thing that calms him is to stick his head out the window, which isn’t always an option. I don’t like allowing that at highway speeds because it could cause eye injury. And I live in Wisconsin, so an open window in the middle of winter just isn’t a viable option! Plus it would be just plain dangerous for Duke.

At home, though, I will give the “go to your mat” idea a try. He is very attached to his bed. Do you think trying a crate would work? He’s never had a crate, but Duke nests and likes his “spots”…maybe a crate would be a good, calming thing for him? He had one as a pup but has not used one since he was about 1 y.o.

I already do A LOT of massage with Duke. Not sure if he likes more or if I do! It’s relaxing for both of us. The word I use during massages is “settle,” which is what the behaviorist advised to say to help Duke associate the word with a calm physiological state. It helps in low-anxiety situations, but not when he is severely stressed out. When he gets anxious, I use a very calm, low voice and talk softly near his ear if I can (ie., other than car rides)—“settle, good boy, good Duke, etc.” Sounds weird, maybe, but it does visibly calm him.

I’ve been to the fearfuldogs.com website from seeing it elsewhere on this forum. I haven’t read the site in-depth yet, but I plan to. I like how she explains fear and doesn’t condone staying away from the dog out of concern for reinforcing the fear. I have never bought into that school of thought—when my dog is overtly afraid, I help him through it, I don’t abandon him.

I’ll check out the swaddle, too. Problem with Duke is that his anxiety is very situational. You just never know when he’s going to freak out (except cars and vets, they’re a given). Thunderstorms and fireworks? No problem. We sat on my front step in July watching the biggest fireworks show in the Midwest. It was going off less than a mile away and he never flinched or made a sound. He has NEVER had issues with SA. But when we go to my sister’s house (which we go to often) and I go in the bathroom or some room where he can’t get to me? He loses it. That even happens at home. I was painting recently and had the room I was in gated off. He whined, panted, barked and paced outside the room the whole time, despite my efforts with stuffed Kongs, treats, his bed with a bone, etc. Even when he could see me (I put the bed right outside the doorway at one point), he still wouldn’t settle down. It’s like once he gets himself worked into such a frenzied state, he becomes almost incapable of bringing himself back. For my part, it just takes a lot of patience and calm, steady voice/actions before he’ll finally relax. I've seen it take upwards of an hour for him to calm down after a particularly stressful episode.

I could go on about other scenarios, like the treachery of nail trimmings, but I think you get the picture! All this is why I decided maybe meds could help. It pains me to see him so anxious all the time. I live alone with Duke and two cats (who he readily bows down to ). And I don't think lifestyle contributes, because our life is definitely NOT chaotic and noisy. Duke gets the best medical care available and goes with me anywhere I can take him. We’re not wealthy by any means, but Duke always comes first. He’s got it pretty darn good, to be honest, and I just want to see him not so stressed out.

Sorry this is so long! But Cracker, I really value your opinion…I’ve seen your other posts and you offer really good, practical advice.

Cracker

Thank you for the compliment.

Regarding the mat. You don't have to crate train if you don't want to, but, if you get a soft sided crate the nice thing is you may be able to use it in the car if he gets to be cool with it. This is the same concept of the mat..since you already do the settle..what you do is the settle on the MAT at all times, using the cue and making the massage and rewards very very special. Then the MAT goes with you, to other's houses, to the car, to the vet etc. This becomes part of the cue for him to relax. The mat itself can be as simple as an old towel you can fold up and go with.
Is your vet nearby? If so, regular drop by's for a settle and treat in the waiting room and if okay with the vet an occasional quick settle with no exam, just a hello and a treat in the exam room can help to desensitize him some. Very few dogs actually enjoy the vet (though I've met a few!) but I've found occasional visits that are NON invasive can make a big difference.

DukesMom

Thanks again. The vet isn't super close, but drop-in visits could still be do-able. And I know the UW would allow us to "train" there if they had staff available. It's the Vet School Hospital at the University of WI in Madison, so I know they always have students floating around. His primary care vet is great and would coordinate this if I asked her. She fully supports behavioral mod with the meds...in fact, she would not have prescribed without this element.

I see what you mean about a mat....something portable and really, really special. As I think about it, we do a variation of this already, just not with the massage/treat association. I always take a certain blanket from home to my sister's and put it on the bed we sleep in (same blanket he lays on in the backseat of the car). He often goes to that bed when things get loud or he gets nervous (3 kids, 2 other dogs...it gets crazy there). Good thing chicken was on sale this week...I think the baked kind is on the agenda for Duke's "mat training."