Situational medication

Clonidine

August 2016: Lyra was prescribed Clonidine as a situational drug: i.e., to be given when I anticipate an event that will likely trigger her sound sensitivity and anxiety. I can give her 1 – 4 tablets in a 24 hour period. Each tablet is 0.2 mg. I’m to administer the tablets 1 – 2 hours before the event.

I’ve tried it three times so far. The first time, I gave her one tablet. She showed no sign of stress or sedation: no side effects that I could see. However, it made no difference to her ride in a car (we took a short trip to experiment). Her stress in the car was the same level as it had been on previous trips with Margaret: i.e., fine at first, some panting and whining after about 15 minutes.

On the second and third trial, I gave her two tablets two hours before a long car journey. Both journeys were longer than any she’d had in the past; both had a stretch along the 401. I was amazed by how well she travelled. She panted while we were on the 401, but much of the time, on the single-lane highways, she was alert but pretty relaxed. She did not seem sedated; on both journeys, we stopped a few times to get out of the car, and she was energetic and aware.

September, 2016 (fourth trial): On the strength of our experience in the car, I wanted to see if Clonidine would help in a more typical event, such as a trip to the vet. A few days ago, I had to pick up her drugs at the vet’s office, so decided to bring her along as a trial. Two hours before, I gave her two tablets of Clonidine (0.4 mg total).  In the two hours leading up to the walk, she displayed normal energy and alertness. We set off at 9:30 am. She was fine until we got to the road leading to the busy crossing. She began to baulk — more so than usual of late. I was able to coax her to come with me, but she tried to run across the busy road and pulled at the leash until we reached the quieter side street. I.e., a higher level of stress than she’s shown in that context recently. She also pulled more urgently to get inside the vet’s office. Once there, she calmed down, greeted people nicely, and did not hide. On the walk home, she was pretty calm — until a motorcyclist revved his engine and a bus squealed its brakes. Even then, she calmed again quickly. However, the journey home was not better “enough” to justify the earlier stress. Does the Clonidine take longer than 2 hours to work in Lyra? Are 2 tablets not quite enough?

March 24, 2017 (fifth trial): I gave Lyra 1 tablet at 7 am, and a 2nd at 11 am. I want to see if spacing the tabs through the day will help with the garbage trucks (it is Friday today). So far, mixed results. She did come to the window to look at a truck while eating cheese (amazing) even before her 2nd tab; but in the yard she began to shut down at the noise again, when the truck was further off. Her spirits/energy seemed a bit low today, but it is very overcast (which tends to affect her mood). Next week, I will try giving her 2 tabs at 6:30 am, then another 2 at 9:30 am. The trouble is, I can’t know when the trucks will arrive, but they do tend to come on our street before midday.

April 28, 2017 (sixth trial): 2 tabs in the afternoon made no difference to her anxiety. This test was just to be sure of the baseline.

May 2, 2017 (seventh trial): My goal today was to give Lyra 4 tabs (.8 mg; her max is .9) and take her across the busy road, since I have a recent video (without clonidine) to compare it to. I planned to take her at the same time of day (late morning). I gave her the pills at 10:25 am. She was in good spirits at that time; we did some training and playing indoors. By 11 am, she was napping on my office floor (not atypical, except that she chose a new corner of the room). At 11:45, I took her outside. In spite of the fact that we often go out at this time of day, she was pretty reluctant. She seemed almost wary of the harness. We did not even get to point D (on our map of the vet walk) which she has been going to willingly of late. In fact, she seemed so down that I took her home and played with her in the garden. She cheered up a little — if more disturbed by neighbourhood sounds than usual — so I tried again. She was a little more willing, but we didn’t get to point D, and she seemed more bothered than usual by passing cars, so I took her home (12:10 pm). She has been mostly sleeping since then (it’s now 3 pm) — which is not unusual if we’ve had a long walk (which we haven’t), she’s very stressed (could be), and/or it’s a very gloomy day (which it is, rather).

Conclusion thus far: I don’t have enough “data” to decide if this will work for Lyra or not. First of all, I’ve only tried half the permitted dose. It may be that — on the walk to the vet — Lyra had enough drug in her system to add a slight sedative effect, but not enough to calm her. Could this have made things worse for her, because she still felt anxious but felt less capable of flight? Short of total anaesthesia (clearly out of the question) a drug is not going to help Lyra unless we find the right match between calmness and ability. We’re not there yet. The only thing I feel able to infer, at this point, is that counter-conditioning is the most important element. Why was the car trip a “success”? Mostly, I think, because of the prior conditioning. The drug may have helped, but I’ve no doubt that it was secondary to the CC work. Lyra has not responded “well” — in the sense of a large, visible difference — to either Trazodone or Clonidine. I have more hope for the latter because at least it does not seem to have any negative effect, and I’ve not yet tried the higher dose. But I don’t think it will help me in the CC stage. My sense right now is that I have to do the CC work first — on Fluoxetine only. This seems to reduce the point of a situational drug! But again, it may be that I’ve got the wrong dose, or the wrong drug, or that such drugs are of less value when a dog is outside and active and feeling a need to be alert.

Update (April 27, 2017): Lyra’s VB suggests we try clonidine again at a higher dose (.8mg, even .9).

Trazodone

August 2016 Update: I am no longer giving Lyra trazodone, as it was only minimally effective for a couple of hours, and worsened her anxiety as it tapered off. Also, at the higher (more effective) dose, it made her shake slightly.

First experiment with Trazodone: March 31, 2016 (50 mg)

Here, she seemed to be more relaxed during the middle phase of the drug, with an outburst of fear near the end.

Second experiment with Trazodone: April 14, 2016 (50 mg)

Here, I saw no improvement in her fear — and perhaps even a worsening.

Third experiment with Trazodone: May 2, 2016 (100 mg)

This time I gave her twice the dose. Since I didn’t know if she would react badly, I used an experiment over which I had the most control: the vacuum cleaner. She did seem calmer than usual; certainly, enough to work on CC. However, her general anxiety seemed to worsen by 6 hours post dose.

Fourth experiment with Trazodone: June 3, 2016 (50 mg)

I tried her on 50 mg again, now that her fluoxetine is up to 30 mg, on a Friday (garbage truck day) to see if it helps at all with her response. It was a gamble, because I have no way of knowing when the trucks will come; however, this Friday was the best bet as we have three items scheduled for pickup: trash, green bin, and yard waste. As it turned out, we were in “luck”: a truck came near the house almost 2 hours after I gave Lyra the trazodone pill. I saw little difference in comparison with non-trazodone GT days — perhaps a fraction less panic.