zoltan-tasi-437454-unsplashWe continue our blog post from part 1 on cat behavior problems and the use of medications for treating them…

Medicines for Treating Ongoing Behavior Problems

Behavior problems that involve day-to-day household issues, such as problems between multiple cats within a household, or ongoing problems, such as excessive grooming, are best treated with medicines that are given long term, such as TCAs, MAOIs and SSRIs.

Tricyclic Antidepressants

Tricyclic antidepressants (TCAs) were first used to treat depression in people. They work primarily by increasing serotonin and norepinephrin-two neurotransmitters that are involved in regulation of emotional activity. They also affect other neurochemicals involved in emotional reactivity. The TCAs prescribed most for cats are amitriptyline (Elavil® or Tryptanol), clomipramine (Anafranil® or Clomicalm®), doxepin (Aponal®), imipramine (Antideprin or Deprenil), desipramine (Norpramin® or Pertofrane) and nortriptyline (Sensoval). Every cat is unique behaviorally and physiologically, so while one TCA might not work well for your cat, another TCA could have excellent results.

Although TCAs were originally intended to treat depression in people, they can also reduce anxiety, manage compulsive behavior and help people with anger problems. They’ve been used successfully in cats to help treat compulsive behavior problems like excessive grooming, reduce reactivity to other cats in the household and treat anxiety problems.

Dosage Schedule

TCAs are prescribed for use every day. If the medicine isn’t taken every day, it won’t work to treat the behavior problem. TCAs are not usually effective the first day-or even the first few days-that they’re taken. Because at least some of their effectiveness comes from the changes they make to the brain, TCAs must be taken for at least two to three weeks before they produce results. Treatment should continue for at least two months before a decision is made regarding the success of the drug.

Health IssuesTCAs are metabolized in the liver and excreted through the kidneys of a cat, so if your veterinarian advises you to treat your cat’s behavior problem with a TCA, he should give your cat a simple blood test to make sure these organs are working well before beginning treatment. If your cat has had problems with her kidneys or liver, be sure to let your veterinarian know. It’s recommended that a recheck blood test be done every year (twice a year for older cats) to ensure that the medicine hasn’t damaged the liver or kidneys.TCAs should not be used with MAOIs because the combination of these two types of drugs can increase serotonin to unhealthy levels.Side EffectsTCAs can increase water retention, and water retention produces dry mouth. As a result, some cats might foam at the mouth, and they might also be extra thirsty. Because they’re thirsty, they might drink extra water. Water retention can also lead to constipation and even diarrhea. All of these effects can lead to house-soiling problems. TCAs can also cause a sudden increase in heart rate.

Monoamine Oxidase Inhibitors

Monoamine oxidase inhibitors (MAOI) work on similar neurotransmitters as TCAs, but they work differently and with less selectivity, so they have a more general effect on the brain. Selegiline (Anipryl®) is an MAOI that seems to mostly affect the neutrotransmitter dopamine. It’s used to treat cognitive dysfunction in older cats, and studies indicate that it can slow aging of the brain.

Health Issues

Some MAOIs can have dangerous side effects when cheese is eaten. Selegiline doesn’t fall into this category, but because some humans have reactions to cheese when taking it, pet parents should avoid giving their cat cheese when she’s taking selegiline.

MAOIs should not be used with SSRIs because the combination of these two types of drugs can increase serotonin to unhealthy levels.

Selective Serotonin Reuptake Inhibitors

SSRIs affect the brain chemical called serotonin. Common SSRIs are fluoxetine (Reconcile® or Prozac®), paroxetine (Paxil®) and sertraline (Zoloft®).

SSRIs like fluoxetine and sertraline have been successfully used to treat a number of anxiety-related behavior problems, such as fearful avoidance of the litter box, fear of other cats in the household or aggression toward other cats. SSRIs are also useful in reducing compulsive behaviors, such as excessive grooming.Health IssuesSSRIs are metabolized in the liver and excreted through the kidneys. Even if your veterinarian does a pretreatment blood test to check liver and kidney health, be sure to let him know of any medical problems your cat has or has had in the past. It’s a good idea to have your cat’s liver and kidneys rechecked each year if she’s kept on an SSRI.SSRIs shouldn’t be used with MAOIs because the combination of these two types of drugs can increase serotonin to unhealthy levels.Dosage ScheduleSSRIs need to be taken every day to be effective. If the medicine isn’t taken every day, it won’t work to treat the behavior problem. SSRIs are rarely effective the first day and, in fact, can increase anxiety in some cats before they begin to have therapeutic effects. Because SSRIs create changes in the brain, they must be taken for at least six weeks before they produce results. Treatment should continue for at least four months before a decision is made regarding the success of the drug.Because SSRIs take a few weeks to take effect, some people also treat their cat with another medicine, such as a benzodiazepine, when they begin treatment with an SSRI.

Serotonin (5-HT) Agonists

Buspirone (BuSpar® or Bespar) is the only 5-HT agonist that’s used regularly in companion animal behavior treatment plans. It’s sometimes used in conjunction with SSRIs and TCAs when treatment begins, but it’s also sometimes used by itself.

Dosage Schedule

Like other medicines that act on serotonin, buspirone needs to be taken every day to be effective. If the medicine isn’t taken every day, it won’t work to treat the behavior problem. Buspirone usually takes about three weeks to produce therapeutic effects, although this period might be shortened if the medication is taken in addition to an SSRI.

Giving Your Cat Her Medicine

If you decide to use a behavioral medication to help your cat overcome a behavior problem, you might run into a challenge when you try to give her medicine. It can be difficult to get cats to swallow pills, and some cats get so upset by the pilling process that they start avoiding their pet parents altogether. To learn how to give your cat the medicine she needs in the least stressful way possible, please see our article on Giving Your Cat a Pill.

Seek the Advice of an Experienced Professional

This article is intended to help pet parents understand common behavioral medications used for cats. It is not intended as a guide to choosing behavior medications. If your cat suffers from fear, anxiety, compulsive behavior or any other behavior problem for which you’re considering behavioral medication, be sure to first consult a Certified Applied Animal Behaviorist (CAAB or ACAAB) or a board-certified veterinary behaviorist (Dip ACVB). These qualified animal behavior experts can evaluate your cat’s behavior problem and help you develop a treatment plan, give you advice on suitable medications, and work with your veterinarian to maximize the success of your cat’s treatment program.

At FCVC we are happy to help you determine what is the best course of action for your feline if they are suffering from a behavioral issue and if a behavioral medication is the right course of action. Give us a call so we can chat with you about your concerns.