Pharmacological treatments for separation anxiety: they’re all the same, right? Puddin’ says “no!”

Separation anxiety is an emotional and behavioral disorder that creates distress not only in pets, but also their caregivers. Dogs with separation anxiety often vocalize, cause destruction in the home, injure themselves, and/or eliminate in the house when left alone. Each of these problems could be caused by other issues so it is important the dog’s health, including emotional health, is properly assessed with a veterinarian. Also, separation anxiety is often part of a broader anxiety issue with many of these dogs experiencing noise sensitivity and social fears as well.

The most successful treatment plans include a layered approach of behavior modification, medications, or supplements, all focused on creating a sense of calm in the dog when left alone. Although many dogs are having a panic response and fast-acting medications with sedative properties may be the most humane approach in the initial stages, milder daily therapies that increase serotonin can be extremely effective. In fact, a daily medication Reconcile® (fluoxetine hydrochloride) is Food and Drug Administration (FDA) approved for the treatment of canine separation anxiety. It is a meat-flavored oral prescription medication typically given once a day. When dosed appropriately, Reconcile chewable tablets reduce anxiety without affecting the dog’s personality or energy levels.

If a dog’s anxiety is managed with a product like Reconcile, is it safe to switch to a generic to save money? Will it have the same therapeutic effects? Approved generics have a good safety record, but relapses in disease conditions have been reported in people switching from brand-name to generic medications.1 As a veterinary behaviorist who treats many dogs with separation anxiety, my experience has been that product consistency can help maintain treatment efficacy. In some cases, the switch from Reconcile to the generic or compounded medication resulted in a relapse in the clinical signs of separation anxiety.

Puddin’, a 2 year-old female spayed Havanese dog, is an example of treatment success correlating specifically with the brand name medication Reconcile. Puddin’ was brought to our clinic because her caregivers reported house soiling and consistent, intense vocalization when separated from people. The problem began soon after they brought Puddin’ home from the breeder’s home at 7 weeks of age. After assessing Puddin’s health and ruling out other behavioral issues (e.g., incomplete house training, reaction to external noises) through webcam observations, Puddin’ was diagnosed with separation anxiety. The treatment plan included many layers aimed at improving Puddin’s panic and distress. After creating an enrichment, exercise, and behavior modification plan, Puddin’ was started on Reconcile once daily at approved doses.

At a 2-week follow-up conversation, Puddin’ was reportedly tolerating the medication well, and successfully progressing through our initial behavior modification steps. Improvement continued in a slow and steady manner over the next few months. Approximately 6 to 12 months after the initial appointment, Puddin’ was still being administered Reconcile daily and observed to be calm and resting for up to 6 hours alone in the home.

At the 14-month mark, Puddin’ was switched abruptly from Reconcile to generic fluoxetine by another veterinarian as a perceived convenience and cost-saving measure for the family. Our clinic was contacted by Puddin’s family after the reemergence of house soiling, and intense whining and barking at the exit door when Puddin’ was alone in the house. There were no other notable changes in the household. Questioning quickly revealed the correlation between the medication switch and worsening of separation issues. Puddin’ was placed back on the Reconcile and the behavior modification plan was restarted. Although it took over a month, Puddin’ was able to be left alone again for over 6 hours. At our 2 year-recheck, Puddin’ was able to be successfully weaned off medications.

Separation anxiety is a very common and treatable problem. Talk to your veterinarian first if you suspect your dog may have this or other behavioral issues. Also, ask about any potential side effects before switching from a name brand to generic formulation, and inform your veterinarian if you suspect a relapse after a formulation change.

References:

Margolese, H. C., Wolf, Y., Desmarais, J. E. & Beauclair, L. Loss of response after switching from brand name to generic formulations: three cases and a discussion of key clinical considerations when switching. Int Clin Psychopharm 25, 180–182 (2010).