The biggest animal consumers of psychotropic drugs are not zoo animals but the ones that live with us most intimately: our pets. Just like the shared rice-gruel remedies of the early twentieth century, we are now giving our cats, dogs, and canaries the same medications we take ourselves. A survey of prescription drug trends among 2.5 million insured Americans from 2001 to 2010, found that one in five adults is currently taking at least one psychiatric drug. Americans spent more than $16 billion on antipsychotics, $11 billion on antidepressants and $7 billion on drugs to treat attention-deficit hyperactivity disorder (ADHD) in 2010. And according to a recent study by the Centers for Disease Control, 87 percent of people who visit a psychiatrist’s office leave with a prescription.
The Prozac prescriptions for Anna Nicole Smith’s Sugarpie, Jacques Chirac’s Sumo, and most recently, Lena Dunham’s rescue dog, Lamby, are indicative of a thriving marketplace for animal pharmaceuticals—psychopharm and otherwise. The U.S. market for pet pharmaceuticals is large and growing, from $6.68 billion in 2011 to a projected $9.25 billion by 2015. Zoetis Inc. is the world’s largest maker of animal medicines. Once a subsidiary of Pfizer, it went public in January of 2013 and raised $2.2 billion in its initial public offering, the largest IPO deal for an American company since Facebook. Elanco, a pet pharma company owned by Eli Lilly, has $1.4 billion in annual sales and is the fourth-largest animal health business in the world. Growth in Lilly’s animal division recently outpaced its general pharmaceutical division for humans. Yearly sales of Pfizer’s animal pharmaceuticals are worth roughly $3.9 billion, with companion animal meds representing 40 percent of the total.
Total sales of pet behavioral medications like fluoxetine are difficult to quantify because many pet owners buy their animals generic human versions from pharmacies like CVS or Walgreens. The Prozac, Valium, Xanax, and other drugstore sales for dogs, cats, and parrots are therefore lumped in with the sale of the same drugs for humans.
The pet pharmaceutical industry is also touted as being recession-proof. Americans may even spend more on their pets during tough economic times. One market research firm recently claimed that people’s love for their pets was an “excellent insulator against recessionary cutbacks.” The same firm reported that many pet owners, both affluent and middle class, were less likely to limit spending on their animals than on their human family members during crises. This has proven to be true not only during the most recent economic downturns but also during the Great Depression, when, as the historian Susan Jones has suggested, families made great sacrifices in order to secure food for their pet dogs and cats.
Psychopharmaceuticals are particularly profitable. The most lucrative human drugs in 2012, after cancer treatments, were antidepressants, mood stabilizers, and other mental health drugs. People spent more on psychopharmaceuticals than on drugs to treat pain, and the market has steadily increased, 10 to 20 percent per year globally, even during the most recent financial crisis. The markup on these drugs is more than several thousand percent, and as David Healy has argued, they’re worth more than their weight in gold.
The scale of investment in the development and marketing of these psychotropic blockbuster drugs, for both humans and other animals, is tied to popular ideas about the illnesses they’re used to treat. The industry that produces these drugs works hard to guarantee their financial success and this means encouraging more people to use them, for themselves and their pets. Two key historical decisions in particular helped ensure the current popularity of pharmaceutical use in the United States. The first took place in 1951, when the FDA (via the Humphrey-Durham amendments to the Food and Drug Act) declared that new medications would be available by prescription only. Before this, people largely medicated themselves, buying what they needed over the counter. Critics of the FDA’s decision argued that it harmed regular citizens by making them completely beholden to a small group of people with the power to prescribe, who themselves were now dependent upon the pharmaceutical industry. A second FDA decision, in 1997, relaxed regulations limiting direct-to-consumer advertising and opened the floodgates to the pharmaceutical marketing machine that would quickly begin to publicize signs and symptoms of disorders that were easily treatable with compounds like the new Prozac.
One of the most vocal proponents of the use of psychopharmaceutical drugs for other animals is the veterinary behaviorist Nicholas Dodman, of the Tufts Animal Behavior Clinic. “One of the things that people called me was the Timothy Leary of the veterinary profession,” Dodman said. Like Leary, Dodman acted as a sort of pied piper, drawing other veterinarians and pet owners to his methods via textbooks and peer-reviewed articles and workshops like “The Well-Adjusted Cat.”
Dodman argues that studies he has overseen, some of which are supported by drug companies like Eli Lilly, prove that Prozac eases separation anxiety and compulsive disorders in animals and also reduces aggression and other “problem” behaviors. He has published research on the use of antidepressants and psychotropic meds to treat everything from compulsive Doberman Pinschers and tail-chasing Terriers to corral-biting (or cribbing) horses and cats who pull out their fur.
In his book “The Well-Adjusted Dog, Dodman argues that psychopharmaceuticals treat a dog’s problems “from the inside out,” though he believes that drugs are more successful if they are used in conjunction with behavior-modification training. The goal, he has said, should be to taper off the medication as soon as possible. In some cases, those in which withdrawing the meds causes the animal’s anxiety, depression, fear, or aggression to return, he suggests an indefinite drug regime.
Dodman prescribes a wide variety of psychopharmaceuticals, as do the many vets who have incorporated his ideas into their own practices. He uses tricyclic antidepressants (Elavil and Tofranil) for depression, phobias, and in some cases of aggression in dogs. But he calls SSRIs like Prozac, Zoloft, Paxil, Celexa, Lexapro, and Luvox the closest thing there is to a silver bullet for treating behavioral problems in animals. He used to believe Valium was helpful for treating anxiety, but he’s now convinced that, like alcohol, the drug can reduce inhibitions, and in dogs prone to aggression, this can make them vicious. It is also addictive. But Dodman still finds it useful for treating acute fear—in cases like Oliver’s thunderstorm panic.
Dodman didn’t always work as a Merry Prankster to the dog legions. An Englishman, he spent the 1970s working as a roving country vet in the United Kingdom, a sort of contemporary James Herriot, the fictional alter ego of James Wight, the British veterinarian. Dodman moved to the United States in 1981 to be a professor of anesthesia at Tufts’ veterinary school. There he began to wonder if psychotropic medicines could change veterinary practice in the same ways they were transforming human psychiatry. Dodman shared his ideas for the first time at a veterinary conference in the late 1980s and later told a journalist for the New York Times that “he saw jaws drop around the room. It was like, ‘Who is this strange masked man?’” Thirty years later, largely through his many publicized success stories, the animal psychopharmaceutical industry is thriving in the United States.
Dodman remembers hearing the former dean of the Tufts vet school call Prozac the behavioral equivalent of the popular wide-spectrum deworming medication ivermectin. “Before ivermectin,” he said, “vets had to carefully choose which dewormer to use to treat intestinal and other worm infestations in dogs, cats, and farm animals. After ivermectin, vets could reach for this one medication to deal with practically all of these problems. All I can say is thank heavens for Prozac and other SSRIs.
Dodman’s colleague Nicole Cottam says that 50 to 60 percent of the people who come to the Tufts clinic want drugs for their dog, cat, or bird. “Most of our clients don’t call or come back after the initial appointment. Unless it’s to get refills. When people leave with a prescription and behavioral exercises, they tend to only use the pills.”
The idea of a pill for pet problems is simply too seductive and, frankly, it’s often useful. I know this from experience.
Oliver received his first Valium prescription after his jump, at the vet hospital. The second one came from his behaviorist. As I mentioned, we were supposed to give Oliver the Valium thirty minutes before a storm hit so that by the time the thunder and lightning descended he would be too blissed out to notice. We were also supposed to play him recorded sounds of thunder and rain. While we did this we were to pet him, but only when he reacted calmly. The duration of the faux-storm training was supposed to increase in single-minute increments until Oliver could listen to the CD peacefully for hours. The behaviorist also prescribed Prozac for his separation anxiety, telling us that it would take a few weeks to take effect and to let her know if there was any change in his behavior. We watched him, anxious now ourselves, but Oliver didn’t seem to be happier or calmer.
The Valium, however, helped. It dulled his thunderstorm anxiety. The only problem was that Jude and I both worked outside of the house, and in D.C. summer thunderstorms tend to happen in the afternoon. Neither of us could return home thirty minutes before a storm hit in order to drug the dog. Five days a week Oliver was on his own when it came to afternoon weather anxiety. We tried playing the recorded sounds of storms to desensitize him, but the CD was less helpful than the drugs. Oliver simply wasn’t bothered by the fake thunder. He endured the listening sessions with benign disinterest.
The behaviorist also suggested we use Valium to treat Oliver’s separation anxiety, telling us to dose him thirty minutes before Jude and I left the house. And she urged us to retrain him around our leave-taking behavior.
The behavioral therapy or training process the vet outlined was supposed to start by Jude and I approaching the front door but not leaving, not even touching the knob. We were to do this repeatedly, until Oliver stopped acting anxious. The next stage was going up to the front door and touching the door knob. When this bored Oliver into not reacting, we were supposed to turn the handle and open the door but not walk through it. This was meant to happen in stages so that in the end, she promised us, we would be able to leave the house without Oliver caring at all. The problem was that this sort of training took weeks, if not months—and we still had to go through the door in the meantime.
We tried to do the exercises. We gave it our best shot. Or to be honest, we gave it our best shot for a while. But it was exhausting, for us and for Oliver. He was so finely attuned to the various stages Jude and I had for getting ready to leave that as soon as we tried to decouple one cue from his “they are leaving me” anxiety, picking up our keys, for example, Oliver would figure out another, such as making our lunches or putting on our work clothes. He may have been dysfunctional and disturbed, but he wasn’t stupid.
Sometimes I stored my computer bag in our building’s shared hallway because even the sight of it would make Oliver start vigilantly watching for our departure, panting heavily and pacing. He also reacted to the sight of suitcases. And the putting on of shoes. And the opening of the coat closet. Possibly, if Jude and I had left for work naked, through a window, with no lunches, no keys, no bags, no shoes, and at odd hours, we could have avoided triggering Oliver’s anxiety.
Like me, a lot of people simply can’t spend the kind of time it takes to retrain themselves and their pet. Or it doesn’t work. Sometimes, as with Oliver’s Prozac, the drugs don’t help either, or the effects aren’t dramatic enough. This unfortunately tends to be the end of the line for most animals. They are given up or forced into what the veterinary behaviorist E’lise Christensen calls “the big sleep” and David Sedaris has referred to as visiting the “Youth-in-Asia.” Behavioral drugs, if they work, can help stave off such mortal consequences.
Dodman argues that most dogs and cats are taken to shelters or put down for “being difficult.” Indeed, 6 to 8 million dogs and cats are given up every year. According to the ASPCA, 3.7 million of them were euthanized in 2008. Aggressive and insecure dogs who menace visitors, or cats that won’t stop spraying on the bedspread are the kinds of creatures most often left at shelters. Dodman argues that the great salvation of these ill-behaving dogs and cats is medication. Though I’m doubtful that medication-only therapeutic regimes are as effective as behavior therapy or at least behavior therapy and medication, psychopharm for pets can be a useful way station on the road to recovery, or a stopgap measure on the way to the gas chamber.
The veterinary behaviorist E’Lise Christensen is a proponent of psychopharmaceuticals because, she says, “Unlike in human medicine, we don’t have inpatient treatment facilities for our patients. If you have a dog that’s jumping out windows into traffic, for example, you have to heavily dose them so they don’t hurt themselves.”
Heavy doses for dogs are not quite the same as heavy doses for humans; dogs’ livers can handle a lot more medication. This is why many dogs end up on dosages of antianxiety drugs that could kill a person. “I have a golden retriever patient right now,” Christensen said, “that’s taking 80 milligrams of Valium every four hours.” This would make a human limp, verging on catatonia, but it’s keeping the retriever from full-blown panic attacks.
Despite the fact that many of her clients are on the same drugs as their pets, Christensen hasn’t seen too many people borrow from their pets’ stash. She believes this is because she’s very clear with her clients about how much higher dog dosages are and the fact that they’ve come to her because they want to help their animal. “What’s much more common,” she said, “is people sharing their own psych medications with their pets.” Thankfully it doesn’t usually harm or help because the human doses are so much lower. Her physician clients use their own prescription pads to prescribe for their pets. “Not my psychiatrist clients, interestingly enough. They tend to wait for me to prescribe.”
And yet for long-term improvements in her patients’ well-being, Christensen doesn’t think the drugs are enough. The gold standard of care, she’s convinced, is medication combined with behavioral training. This means keeping the animal from whatever triggers their fear and anxiety, whether it’s being left alone or hearing a vacuum cleaner, while therapy is taking place. “If the animal isn’t being exposed to their triggers,” she said, “you can work with them to make whatever scares them less scary.” I told her about my experience trying to retrain Oliver about the front door and she admitted that all of this is easier said than done.
Recently she treated a nervous dog who lived in Brooklyn. He was prone to biting strangers out of fear and anxiety. The dog became stressed simply walking down the sidewalk and his owner, a young woman, had a hard time keeping people at a safe distance. “She would tell passersby that the dog would bite and to keep walking but people actually got mad at her for not letting them pet the dog.” As a solution, the woman moved to a house with a yard in White Plains and now commutes to work in the city. Her dog is much more relaxed. Christensen realizes this is too much to ask of most dog owners. “If I could change one thing about New York City,” she said, “it would be that people would treat a dog on the sidewalk just like anyone else they didn’t know. If you were walking down the street with a human family member, for example, only the creepiest strangers would think it’s okay to come up and stroke them.”
This made me think of self-identified “dog people.” Many men and women who describe themselves this way will bend down into the personal space of dogs they don’t know and extend an overconfident hand within muzzle reach, or aggressively ruffle fur on heads or hindquarters. These people are a bit like self-described ladies’ men. That is, if you have to say you’re a dog person, it probably isn’t true.
Christensen counsels many of her clients to act as buffers for their nervous animals on city sidewalks, stepping between the dogs and would-be strokers. The humans become, in essence, therapy animals for their own pets.
When she was a veterinary student and resident at Cornell University in rural upstate New York, it was easier for Christensen to ask her clients to keep their pets away from their triggers during behavioral training. A dog who couldn’t be left alone without panicking, for example, could accompany their human more places. In New York City, her clients can’t keep their dogs with them all the time. Like many urban veterinarians, she is then more reliant on behavioral drugs to blunt the animals’ fear and anxiety while they’re still in therapy, a process that can take a very long time. “By the time many dog owners get to my office,” she said, “they are verging on emotional bankruptcy. These people are desperate and exhausted. They’re trying hard.”
She has learned that most are capable of no more than four or five minutes of behavioral training per day. Ideally she would have people do fifteen minutes twice a day, but most of them can’t do that. I told her about my disappointing results trying to retrain Oliver and what my failsafe method was when I reached my wit’s end. I used the car. Oliver always calmed when I left him in our Suburu. I even daydreamed about opening a boarding kennel for anxious dogs that consisted of a parking lot staffed with nice people to deliver food and water to the cars and take the dogs on walks.
To my surprise, she didn’t think I was crazy. “Many behaviorists actually encourage their clients to use cars to keep their dogs calm when they have to leave them alone,” she said. “If you live in a temperate climate, are really careful, and it’s not illegal in your city or state, this can be a good solution.” The reason, she told me, that Oliver and so many other nervous dogs feel better in cars is because we trained them to be comfortable there without knowing it. Few people leave their dogs alone in the car for long, at least at first. So the dog learns, incrementally, to stay in the car for longer periods of time and no matter what, his or her humans always come back.
Doggy ’s Little Helpers
Dogs exist as they do, emotionally and physiologically, because they tend to like being around us. The dogs we have fed, treasured, and bred over the past fifteen thousand years are precisely the kinds of creatures that are more likely to suffer when separated from their human companions for most of the day. Contemporary canine anxiety disorders like Oliver’s are the result of a trait we prize highly and have selected for in dogs: they enjoy being around people, particularly their own people, and are glad to spend time with us.
Today’s pet dogs are a bit like Ham the chimpanzee, sent into space in 1961 to find out if humans could do it too. That is, many dogs living in contemporary urban and suburban households are occupying alien lands. They simply haven’t had enough time to evolve into creatures who do well left alone all day with little exercise, social time, and ability to express their doggishness—something the Germans refer to as Funktionslust, taking pleasure in what one does best: a cheetah sprinting at full speed or a bat pinging his sonar through the night. Dogs are built to run and sniff and chase and hump indiscriminately. Most of them are happiest rolling in dead fish, pulling tampons out of the trash, and licking their genitals or someone else’s.
Many dog owners are content to meet a dog on human terms but are unwilling to do so on the dog’s terms. That is, we are thrilled when dogs are excited to see us at the end of the workday, but we don’t want them to be running and jumping in circles, tails wagging explosively, paws everywhere, when we’re at work. Instead we hope they’re sleeping soundly, calmly grooming themselves, or perhaps taking a gander through the living-room window, not in longing but just to see what’s there. This expectation isn’t fair. It reminds me of times I’ve fallen for men whose idiosyncrasies intrigued and captivated me at first, but as time wore on, those same traits began to drive me nuts. The fault was mine. You can’t blame a man for being the kind of man you fell in love with. And you can’t blame a dog for being a dog.
Most urban and suburban dogs are only encouraged to be themselves for a small fraction of the day. In my neighborhood just outside of San Francisco, the early evening, right before sunset, is that fraction. You can feel the collective wags of thousands of tails, the expectant panting at the door, the anticipation of the click of the leash on the collar, and then the overwhelming joy of going out. Out! They flood the sidewalks around my house with their pent-up frustrations, pissing and smelling and dragging their people along behind them like water-skiers. At the park the humans stand around tossing balls or chatting idly or calling their dog off another’s rump. A half hour or an hour later, it’s back to the house for dinner, some petting, maybe some television with the humans, and then bed. But this is not enough time for dogs to do dog things, even if they get to do it in the morning too.
The alternative for many people is simply not having a dog. For most of us, if you live and work in a city, you can’t move to a farm just because your dog would like it better. If your dog hates being alone, you can’t simply quit your job to stay home with her. There are other options, of course, but none is simple. You could hire a dog walker to visit one or more times a day, but they’re expensive. You could move to an apartment near a park where the dog could be off leash every day, but perhaps the market’s bad and you can’t sell your condo. You could get another dog to keep your first dog company, but maybe your landlord allows only one pet. You could spend a lot of money on dog toys to stuff with peanut butter or marrow bones to freeze and then leave hidden around your house like a macabre Easter egg hunt, but you forget. This is life. We love our dogs, we try our best, but we often fail them. The truth is that all the squeaky plush toys in the world can’t compare to a leashless life of daily stimulation and plenty of time with dogs, humans, and other animals. That is the kind of life dogs had before most people went to work in offices, factories, shops, and other places canines aren’t welcome. And it is precisely the kind of life that keeps most of them from licking their paws into oozy messes or tearing up the sofa.
When dogs spend long hours doing nothing, they have too much energy to curl up into happy, satisfied rounds at the end of the bed. Their energy has to go somewhere, and for the less sturdy, or simply the more prone to anxiety or compulsion, that somewhere is Crazytown. This town has myriad diagnoses and one of the more common is separation anxiety. Pharmaceutical companies have taken note and even helped to shape ideas of the disorder.
The humans who own the more than 78 million pet dogs in the United States are a large market for companies like Pfizer and Eli Lilly. In 2007 Lilly launched Reconcile, chemically identical to Prozac (which went off patent in 2001), but unlike Prozac, it is beef-flavored, chewable, and FDA-approved for treating separation anxiety in dogs. Simultaneously the company released results from a Lilly-funded study arguing that 17 percent of U.S. dogs suffer from separation anxiety. A 2008 study estimated that 14 percent of American dogs have some degree of the disorder.
Lilly’s Reconcile website is the virtual equivalent of getting licked by a puppy, one that is good at making her owners feel guilty. Phrases like “I wonder if he tears things up to get even with me. I wonder if it’s my fault” appear in flash animation at the top of the screen. A video clip of a veterinarian with a southern drawl runs through a list of separation anxiety symptoms: drooling, destructive chewing, pacing, depression, anorexia, excessive barking, and “licking of coat.” As the vet speaks, a young Golden Retriever mauls what looks like an expensive high-heeled shoe.
An older version of the site had a large banner that read “Separation is inevitable. Now anxiety isn’t” and offered dog-bark ringtones and a glum-looking Beagle screensaver. It also linked to a study on the effects of Reconcile, used along with behavioral training, on separation anxiety. The study, on 242 dogs, was published in Veterinary Therapeutics in 2007 and paid for by Lilly. The dogs were split into two groups: one received a beef-flavored placebo pill and the other received the drug. Both groups also went through behavioral training. By the end of the study, anxiety symptoms in all of the dogs had diminished—by 72 percent in the Reconcile group and 50 percent in the placebo group. While the study does suggest some drug efficacy, it demonstrates the importance of behavioral training far more effectively.
There is also Clomicalm, introduced by Novartis in 1998. The active ingredient in the drug, clomipramine, is identical to the main ingredient in the company’s antidepressant/OCD drug for humans, Anafranil, but this version was FDA-approved just for animals. Novartis describes Clomicalm as a medication for treating separation anxiety in dogs, but, as is the case with the human version, clomipramine is also frequently used to treat other signs of distress. In one strange experiment twenty-four Beagles were sent traveling in a truck for an hour, on three different occasions, to see if the drug helped ease travel anxiety. The results were inconclusive, but the Beagles drooled less than they normally did. The drug has been more successful in lessening tail-chasing in dogs and feather picking in cockatoos.
Depending on the dosage, the Clomicalm box features a Yellow Labrador, a Golden Retriever, or a Jack Russell Terrier. The dogs seem happy and alert, tongues lolling. Medicating a small dog costs roughly $600 per year. Larger dogs need larger doses, which cost more. The website allays consumer fears, and perhaps owner guilt, by assuring visitors that Clomicalm tablets are not tranquilizers or sedatives and won’t affect your dog’s personality or memory. Instead, the drugs helps animals “return to a normal life.”
From “Animal Madness” by Laurel Braitman. Copyright © 2014 by Laurel Braitman. Reprinted by permission of Simon & Schuster, Inc.