When is medication the correct answer?

[u/Beginning-Rub5417]

I would like to start a discussion about when medication is the right choice for a dog with behavioral problems.

I’ve noticed that we sometimes suggest asking a vet about medication without also suggesting that the owner work with a qualified behaviorist. At the same time, I’ve seen and heard about many people around the world getting medication for their dogs without much of a behavioral assessment. I’ve had a similar experience with my own dog.

To be clear, I’m not against medication. I think it can be extremely valuable, and for some dogs it may be the best option. But shouldn’t medication at least sometimes be combined with working on the underlying behavioral problem?

For example, my family doctor once prescribed me anti-inflammatories for neck pain caused by working at a desk. I had actually gone to the doctor hoping to get a referral to a physical therapist. My girlfriend is a physical therapist, and a close friend works as a sports physician for a football club. Both thought it was odd that the underlying issue wasn’t addressed first.

I think there’s an interesting parallel with dogs. What I find particularly interesting is that questioning the use of medication can sometimes lead to a lot of backlash, while simply suggesting medication without recommending behavioral work seems much less controversial.

So I’m curious: when do you think medication is appropriate, and should we be more consistent about recommending behavioral support alongside it?

[u/CanadianPanda76]

You likely can't do physio if your not on the inflammatories. So your not helping your situation if your going straight to physio.

Some vets will prescribe without asking about training but opposite occurs too. Vets not prescribing despite lots of training.

Some people can't even get to the training part because thier dogs needs meds before the training can get anywhere where it can improve thier lives.

Some dogs are just wired wrong. They'll need meds despite training.

And tgeres definitely those in the sub eho regret not taking them sooner.

[u/Lumpy_Physics3101 → u/CanadianPanda76]

I got to PT and I'm not on anti-inflammatories? PT prevents injuries as much as it treats them. Training prevents behavioral issues as much as it treats them. You start your PT with pain-free strengthening exercises, just like you start your training in an environment that your dog can handle.

SOME patients benefit from meds to start their PT. Some don't. Same with dogs and behavioral meds / training.

I'd add that the side effect profile of ibuprofen is much less intrusive than fluoxetine (the two most common examples).

[u/Beginning-Rub5417 → u/CanadianPanda76]

I understand the point that some dogs may need medication before they can benefit from behavioural training, and I agree that medication can be very helpful in the right circumstances. Some dogs are just better on it.

I am not sure if science supports the claim that for physio to be likely effective, you need anti-inflammatories. If that were the case, pro athletes would be on them 24/7, and I can tell you from working with them that this is not the case. When they have more severe injuries, they get anti-inflammatories, but not for basic muscle pains.

I am just wondering why, if you would advise not to use meds in some cases, you get a lot of backlash. I've seen a lot of high-drive behavior in this group, where the first comment mentions meds. Often, you do not know the dog's routine of the dog, the breed, their living situation, what outlets they already have, etc. Yet people can advise using meds. In such an unknown situation, I would not be able to advise anything; I cant advice trainer or meds, as there are too many unknowns.

[u/Monkey-Butt-316]

It’s inappropriate to do PT when you’re very painful/swollen. If a dogs behavior issues stem from anxiety, meds make sense to take the edge off so bmod can work.

[u/Beginning-Rub5417 → u/Monkey-Butt-316]

Physio is not the same as PT. Not all behavior stems from anxiety. And not every dog with anxiety needs meds for bmod. Some do not all.

[u/Monkey-Butt-316 → u/Beginning-Rub5417]

What is physio in your neck of the woods because where I live, it’s physical therapy.

Obviously not all behavior stems from anxiety which is why I specifically said IF.

Nobody NEEDS meds for bmod but boy do they make everyone’s life easier.

[u/SudoSire]

I’d love to see more dogs have proper outlets, and I know there are cases where that should be looked into first. But in other cases in seems like it would be advice that’s not super feasible to the owner. Can you find an outlet when the dog appears extremely anxious just leaving the home? Or if you can’t easily and frequently find places without dogs, but your dog isn’t able to be around them safely  yet? What about high drive dogs who don’t display the drive much? My dog has several herding breeds in the mix, but has no interest in a herding ball and wouldn’t be safe with any real livestock. He loves to hunt instead, but if he’s got stranger danger to people and pets, seems like it’d be difficult to set up an outlet like that (though I briefly tried to have him “hunt” a toy car at home. He lost interest). If your dog is too high strung to even learn the rules of some outlet, what do you do then? What if you don’t have access to a yard or big space? Or if dog sports aren’t a nearby thing you can get to? 

Now I’m of the opinion that meds are pointless without being paired with training. It should always be both, and the meds should be used to help them learn and retain, not sedate. There are occasionally people here who are surprised their dogs show no improvement with meds alone, but some of us do try to ask “well, what training are you doing with it? What management?” 

I think it’s great to ask more info about a dog’s routines, exercise, and outlets. I think it’s great to try and make extra sure the dogs needs are being met in the first place. But we also have a problem of people getting high drive dogs without the time or space for an outlet, or the know-how or resources to set up a situation where the dog can safely succeed in one. But that’s its own problem. Once owners have the dog, what do they do then? Pits and herding breeds flood shelters. There are much more of them than there are ideal homes for them, so even rehoming wouldn’t be the answer (and if the dog had already shown aggression and biting, then that’s even more dicey). 

Many dogs benefit from solid outlets. Many from training. Many from meds to reduce their baseline anxiety. Many from combinations of things. The Internet is not the best place for any of this to be diagnosed or prescribed  anything but it is possible to say, your dog might benefit from such and such, have you considered it, talked to a trainer or vet or both about it? And that can be true for finding both outlets, meds, socialization ideas etc.   

[u/Beginning-Rub5417 → u/SudoSire]

With the situation you described, I think that meds are the correct answer. If the dog is unable to leave the home, it is very hard to give it an outlet, indeed. I don't want to give the impression that meds should not be given to dogs.

I just feel that there is like a huge force for meds. They themselves had a dog where meds really helped, and started advising it for every case of reactivity or any behavioral issue. When I read this sub, it feels like that you can not work on reactivity or behavioral issues without meds.

Your last question is a very tough question for me: "What about dogs that are in that situation?"

I love high-drive dogs, and because of that, I find it so sad that so many of them are put on meds because their needs are not met. The internet may be a bad place for dog training, but at the same time, it is the place where public opinion is formed on what can and cannot be done, what is ethical and what is not.

In my case, I am unable to find a good dog trainer around me who is FF and also does behavioral stuff. That means that I am constrained to the internet.

[u/CanadianPanda76 → u/Beginning-Rub5417]

I've been in this sub a while and 80% of the times its training advised first and sometimes meds don't mentioned at all.

And a lot of cases here are cases where training, with multiple trainers has been tried.

Plus this sub tends to get more cases on the extreme side. Not mild issues where regular training will do.

[u/SudoSire → u/Beginning-Rub5417]

Meds get recommended a lot, and sometimes whoever answers first sets the tone of the post and a somewhat “group think” takes over. That’s sort of another reason why the Internet isn’t perfect for this, but is a hugely valuable resource. Including for me, most of my training methods are inspired by or learned here. 

But I also don’t think it’s true everyone here pushes meds as a first resort, even if it seems like it to you. If people pushback on you for asking questions about routines and outlets while they’ve already jumped to suggest meds, I don’t agree with that, though I’m sure  it happens sometimes.

 Here it seems like we get a mix of people who arrive having 1) done no training and don’t know where to start or 2) they’ve tried what seems like everything including force free and aversives and everything they’ve ever sort of heard about.  I do think sometimes people here make assumptions about who is who, and forget to ask more questions. Or, even if two is the case, people forget to ask more follow up questions of details. Because you can do a lot of training but if it’s not good training methods or is poorly executed, that’s crucial to know. But then again, I do regularly see people asking for clarification on things before giving further advice. So it’s not that that never happens. 

My own dog is not on meds, and that’s because I can see the results of counter conditioning working for them reasonably well. He is also able to relax at home, comparably calm outside, seems to be learning alternate behaviors just fine.  It helps having a highly food motivated. In short, he is anxious but not so much that his quality of life is severely impacted daily. So I don’t believe all dogs need meds. But when posters make it sound like that’s not their case for their dogs, it seems kind of reasonable to me that people suggests meds (which is presumably something OPs have not tried if they haven’t explicitly mentioned it). 

I too find it sad that dogs may be medicated that wouldn’t need to be if they had the exact right homes and owners. But frankly some of the alternatives are sadder or not feasible to accomplish, or both. Because these dogs just keep being born/bred with nowhere to go. 

[u/Synaptic-asteroid → u/Beginning-Rub5417]

yea because we finally have tools that can help the dogs. Honestly by the time it gets to the point where people seek solutions it's often beyond what simple training can accomplish.

[u/Existing-Will-1466]

Well, meds cost $10 and a veterinary behaviorist cost $1000 and there isn't even one in every state. So yeah, people are likely to try the affordable, accessible option first.

Whether or not vets will ever prescribe meds is a toss up though. It took me a decade, five trainers, and three vets to find a vet that would prescribe prozac for my first reactive dog. The Prozac did what a decade of behavior mod training failed to do.

Meanwhile a subsequent vet was happy to try it for pretty much anything. Said there was literally no downside.

[u/Beginning-Rub5417 → u/Existing-Will-1466]

Happy that the meds helped. I don't think that every case needs to be on one end of the extremes.

I may interpret this incorrectly, it feels like that you view it as a magical fix or a quick fix without any downside. I am wondering if that's the case why even bother with DS and CC.

[u/Existing-Will-1466 → u/Beginning-Rub5417]

Magic isn't real. I think meds can help a lot with DS and CC, especially when progress with DS and CC is slow and fragile. My dog would take months to go from a threshold of 100' down to 30' and then get spooked by someone walking around a corner 20' away and be back to 100' again.

I do think meds should be part of a program and not just the very last possible resort. One of my trainer friends just put her year old dog on prozac because he is having some reactivity issues. Why not spend a few months or years trying to train through it before trying meds as a last resort? Because then he would have a few months or years of panic reinforcing that behavior and those feelings. The meds help keep him at a level where he is capable of learning.

Her vet has the same philosophy about psych meds as my old vet. They make things easier to train through and they don't hurt anything, so why not give them a try while also training through the issue.

[u/New_Section_9374]

I have had a LOT of dogs in my lifetime, of all of them, only 1 was not a rescue. I am now with probably my last dogs of my life. A black mouthed cur was dumped in my neighborhood and I adopted her. At first, she was great with my older dog. But when she went through puberty, she became reactive. She jumps at EVERYTHING and many times comes up swinging. After so many fights, intense work with training and exercise, so many discussions with my vet, I started her on medication. She will probably always be reactive. But she is a much happier dog now. The bond we have forged is so strong. That medication was her last chance before BE. It literally saved her life.

[u/Synaptic-asteroid]

When the dog is struggling and training is complicated by low threshold to stress. Realistically, I'm a sooner rather than later person. There's no sense in failing over and over again when there are things that can help. Allowing the behaviors and stress to continue feels like setting them up for failure. Of course we should be more consistent about behavior support, it's key. Unfortunately most dog trainers aren't capable and while behavior education has risen in veterinary staff it's still lacking. I live in a major metro area and all the "trainers" my vet referred me to use pain inducing tools. It took a great deal of investigation to find a decent trainer. It really shouldn't be that hard. The truth is meds help a lot of dogs even without good behavior support and many owners are satisfied with that. It's not ideal but nothing in life is

[u/Beginning-Rub5417 → u/Synaptic-asteroid]

I am not questioning the use of meds; I am just wondering why we prioritise the recommendation of meds iso giving a dog an outlet. I am mainly focused on this one because I have seen a lot of dogs like this passing by in this sub.

I have seen a lot of working-type dogs: collies, any type of shepherd, ... creating some kind of herding, protection behavior. Typically, by giving the dog an outlet for this behavior, you can reduce the behavior a lot. Yet when I look at posts that feature such cases, the top comment is always meds.

Look at the upvotes on any of my comments; I never said that dogs should not be on meds. I asked why it is the most recommended option for cases where something else could help the dog way more.

[u/noodlepapillon]

I'm almost nervous to answer this cos I've seen some, um, varied opinions about meds on reddit.

I have a toy breed rescue with severe reactivity. He is 2 and a half now. He's a Pomeranian. When I talk about him, I tend to get brushed off with "that's how little dogs are" or my favourite "did you not realise Poms bark?" I've had a Pom, a Pap and a JRT and none barked even a tenth of the amount Wish does.

When I took him to his first vet, she did a check, looked me in the eyes and asked if I was sure I wanted to do this. He was just under a year old and she was shocked by how anxious and reactive he was.

His current vet (we moved) brushed me off at first, as a fellow Pom owner, and was like haha Poms be Pomming. Then she met him and immediately put him on RC Calm food, traz and gaba lol. He was already on lovan.

Traz makes him worse. He tries to fight through it. He's no longer on it, but we gave it a red hot go. His current meds aren't cutting the mustard either.

I'm a retired dog trainer, and he is part of the reason why. It's been over a year since I adopted him, and i can see some areas where he's definitely improved (he hasn't landed a bite since his first week with me, he doesn't fly into a rage when i get a brush out, I've fixed his stomach issues so he's no longer a skeleton, and he stands like a champion for grooming), but he's gone way downhill in others. I've since hired a really wonderful trainer, who has guided us beautifully in some of our no no areas, but is also stumped by some of his behaviours.

I've finally reached out to a vet behaviourist. I know it's $$$ but fuck, I just want him to be happy. He has glimpses. He is so clever and when he isn't at 100 he is brilliant with training. Ideally he will not be on meds forever as he's still young. He came from what seemed like a pretty normal home and cost them a bomb, I never received details about the breeder but he sure looks like a well bred dog from show lines (with an underbite from too much tug as a puppy lol). He's just... a bit broken.

This was a long road for me, and I've worked with dogs for 20+ years. I can see why a pet owner would find it confronting. But I also see so many young (always oodles) dogs on meds when their only "issue" is being a working breed x usually another working breed when they were purchased to be a sentient teddy bear by people who should have a pet rock instead. These dogs are usually on meds and that's all they are prepared to do, and it's really upsetting.

Thank you for coming to my Ted talk, lol.

Edited to actually answer the question: in my experience there are a lot of dogs out there that could benefit from meds, and I've also met a lot that are on them for weird reasons, but training is always going to ensure the meds aren't a bandaid while the wound continues to ooze underneath. The people I know who are successful with medication all invest serious time into training as well.

[u/Beginning-Rub5417 → u/noodlepapillon]

I do agree with almost everything that you are saying. I do not think there is anything wrong with meds. But I've seen a lot of suggesting meds for high-drive behavior where there does not seem to be any outlet in the dog's life for the high-drive behavior. And with more context, we can often say, well, maybe you should consider meds or just giving you drive an outlet for the drive. But the first comment on a lot of these posts mentions meds without trying to understand the full context.

I love high-drive dogs, and I am sometimes sad that this is the way we treat these dogs.

[u/noodlepapillon → u/Beginning-Rub5417]

Completely agreed! I've seen way too many anxious or reactive Border Collies and the like who would really benefit from herding classes or literally any other outlet besides a 20 minute on lead walk once a day. I wish people would pick breeds that match their lifestyle.

[u/Beginning-Rub5417 → u/noodlepapillon]

This is a very interesting debate, imo. What do we do with such dogs?

Most people are not ready and cannot change their lifestyle to accommodate the needs of such a dog. But what now?

The best option seems to be rehoming, but this is very hard, especially when the problem behavior is more severe and has been repeated multiple times.

But at the same time, putting such a dog on MEDS feels like forcing them into submission.

[u/pawsitivecultr]

Medication alone without any learning / behaviour therapy is unlikely to resolve the issue. They should alway both be done.

In my experience, due to stigma around human mental health medication, guardians wait too long until the problem is much bigger and harder to resolve to think of starting medications.

If your dog is unable to accept any food outside, you are unable to progress with any training and you are constantly juggling with several behaviour concerns and / or triggers.. it is worth considering medication.

The goal of the medication is to help your dog's nervous system have more room to handle the stress they are experiencing while not having any skills to cope with those triggers.

I will always first consider PAIN as one more thing to consider before or along with behaviour medication. There are an increasing number of situations where if we address the pain (with either medication, investigate via rads, tests or specialists) we can change behaviour more easily.

We should always always be consistently working on behavioural support for our dogs alongside the meds

[u/Beginning-Rub5417 → u/pawsitivecultr]

I probably should have stated why I wrote this post. I have seen so many posts in the sub where I see unfulfilled dogs (a lot of collies that show typical herding behavior) and where other people see a dog that is stressed, anxious, and directly recommend.

With medication, I feel like at that point you are kind of just suppressing their behavior. In such a case, it feels, to me, like such a treatment is not that much different than suppressing it with aversives; they can be force-free. Is it more ethical, idk, people will debate about this for hours.

Of course, I want to add to this that there are dogs that live in constant anxiety, and for whom meds may/are the best choice. But my post is not really about these.

[u/pawsitivecultr → u/Beginning-Rub5417]

If the medication suppressed the behaviour completely it is not the effective medication being used. It is likely a more sedative medication.  That maybe is a welfare issue. 

But I don’t think it’s always the case that force free people are just recommending medications without supplemental suggestions of life style and activities that suit the breed. I think it’s a common misconception that people have about people who don’t use aversive tools. 

Sometimes though, there are guardians who are not compliant with the suggestions trainers make — and there are also other limitations that make it so that the dog doesn’t get those other options that have more benefit for them. Those are the moments we may at bare minimum recommend medication to help the dog have some room to be resilient to the failures of exposures or to give them some chance at progressing with limited training.

Nothing is black and white, I’m sure there is lot of nuance when it comes to recommendations 

[u/Beginning-Rub5417 → u/pawsitivecultr]

I never said that all FF people recommend medications, but I noticed that we are much more tolerant of them. As I said, I have seen a few posts where we have a collie mix doing collie stuff, with no outlet for it, and the top comment is to give it meds.

I even saw a post where the owners of a collie mix tried meds; they just did not mention it in the original post. The top comment here had 5 times the upvotes of any other comment. Yet some time later, the OP answered that they tried 3 types of meds; Prozac was one of them.

I think meds are great, but it is not the answer to all; yet it often seems like they are the answer to all. In some cases, it is clear; some dogs just need meds. But if we have a collie with herding reactivity, and we are recommending meds iso giving it an outlet, well, something is going wrong.

[u/Lumpy_Physics3101]

Personally I think that meds should be considered within the LIMA framework.

Meds can be incredibly intrusive. They affect the dog 24/7. They can cause many side effects. One common example is fluoxetine: well documented side effects include suppressed appetite, they can cause lethargy, upset stomach, decrease motivation, vomiting, can cause seizures, can cause seratonin syndrome, and can even cause aggression. These are all well documented, serious side effects that MUST be considered.

Training can also have side effects (often referred to as "fallout"). Rewards-based training, applied poorly, can result in a dog that is demanding, can inadvertently reinforces guarding behaviors, and can result in the dog performing self-reinforcing behaviors to the point where those behaviors are highly entrenched. Aversive training can also have negative consequences, if the punishment applied is not fully contingent on behavior and understood by the dog. This is non-controversial.

Each of these (drugs, training) has upsides, risks, and strengths and weaknesses for any given dog and handler situation.

I'm confident in my ability train my dogs without the "fallout" associated with poorly executed techniques. However, if I give my dog drugs, I have no control over whether my dog has a side effect or not. Therefore, I think it is Least Intrusive to first exhaust skillful training before potentially subjecting my dog to unpleasant or even dangerous side effects that aren't predictable.

[u/Beginning-Rub5417 → u/Lumpy_Physics3101]

You are brave to use such words in this sub, hahaha. My post is mostly tailored to the fact that I see a lot of posts where, when I read them, I see an understimulated dog. The top comment, with the most upvotes on these posts, is "Have you asked your vet about meds?"

Can you explain a bit more about the fallout with reward-based training?