Opinion piece on veterinary psychopharmacology
By Laure-Anne Visele, November 2014
Facile use: Just pop him a chill pill
I am staunchly against the willy-nilly use of medication. But when the problems are so serious that the dog is suffering, or just can’t learn anything – including behavioural therapy – it’s time to do something.
Let’s be crystal clear here: I do NOT promote the facile prescription of psychopharmacology – I promote its responsible use:
- For the right cases: Based on a behavioural evaluation by a qualified professional, and only for the cases that will not respond to behaviour therapy alone and/or where the dog’s welfare is in acute crisis because triggers cannot be avoided.
- At the right dose: Aiming for the Goldie Lock zone (therapeutic range) showing improvement without adverse effect,
- For the right duration: Ramping down as soon as the improvements are stable,
- Together with the right behavioural treatment: Only used in the context of supporting behaviour therapy
- Using the right product: Surgical precision, not scorched earth, and
- With the owner’s informed consent: With the owners fully briefed about the potential adverse effects (and their likelihood).
Adverse effect: And then he turned green and grew wings
Do me a favour: do some reading on (veterinary) psychopharmacology (Horwitz, Crowell-Davies, and Overall – 2013 edition) to get the facts before you jump on your conspiracy theory soapbox. It’s not perfect, there may be (transient side effects), the dosage/prescription might be a little touch and go at the beginning and some dogs have to be medicated in the long-term, but please share well-researched concerns and not the latest internet conspiracy theory or naturopath marketing scheme.
When it comes to adverse effects, the vets want to prescribe in the Goldie Lock range, the therapeutic range: high enough for a therapeutic effect but low enough to avoid severe adverse effects. What adverse effects you might encounter should be either mild and transient. If you report serious adverse effects, your vet will seriously consider the costs and benefits under this medication/dose and switch to a more appropriate medication/dose if need be.
During pharmaceutical research trials, adverse effect have to be reported even if these concern a minority of the patients and at very high doses. The issue is… The only massive trials testing the effect of psychopharmacological substances on dogs were in the framework of animal testing for human-targeted drugs. They focused a lot on toxic doses (on dogs) but not so much on therapeutic effect, therefore. This tells us that we have very appropriate safety data on psychopharma and dogs, but that most of our knowledge about therapeutic doses comes from clinical cases – no massive trials with huge sample sizes.
Even so, the safety process in human trials is not perfect as disappointing – or worse – results have a nasty tendency of finding themselves buried is drawer (Goldacre). But this tends to happen on human trials and medication with a wide toxic range won’t even get phase II approval. That, and vets swore an oath of beneficence and non malevolence. They won’t be prescribing risky medications just to line their pockets. They will be prescribing the behaviour medication that has the best chance of helping your pet.
The label warns you of possible (rare and transient) side effects and if you detect them, you should tell the vet pronto. Severe adverse effects are not the norm and need to be addressed.
I am not trivializing the very real adverse effects reported, particularly when the dosage/medication was contraindicated for that individual patient. If something is demonstrably effective, chance is it will have side effects. In pharmacology like in anything, there’s no such thing as a free lunch. But I am asking you check their frequency and severity from sources other than emotional testimonies and anecdotal evidence before you go on a scaremongering campaign that might deny some dogs the help they need.
Please be a good advocate to your clients and guide them without bias, even if it goes against your dislike of psychopharma. People going through the hell of owning a dog who is severely disturbed do not need to carry the weight of your blanket mistrust of big pharma.
Same debate rages with human mental health
The parallels with human mental health abound: human psychological disorders are no more a question of ‘getting used to it’ or tough love than canine ones. Dogs, much like us, can suffer from genuine mental health conditions that require more than behaviour therapy alone.
Recognizing an individual dog might need pharmacological help is not an admission of failure on the part of the (canine) behaviour therapist; no more than a human psychologist is incompetent because he recommends medication. The meds are meant to support behavioural treatment, not replace it.
Determining whether meds might be indicated is as much part of our job as mastering training protocols. Sure it bruises our egos and wallets (referring out can mean we transfer the whole behavioural plan to the vet). But that’s tough luck. We’re big boys and girls and we have to get over ourselves and keep an eye on what really matters: the dog.
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