Washington - "There are a few options for treating your depression," I say to the patient. "But I think this medication may help."
The patient starts laughing. "That's pretty funny, Doctor."
"My dog takes the same pill!"
The interface between pets and mentalhealth care has been a hot-button issue in recent years. The evidence that therapy animals can help treat people with psychiatric issues is patchy, yet emotional-support animals seem to be everywhere, perhaps most noticeably on planes. The Internet was in an uproar not long ago over reports that a traveller attempted to bring an emotional-support peacock onto a flight.
Meanwhile, veterinary providers and pet owners are paying increased attention to such problems as separation anxiety, compulsive behaviors, phobias and aggression in pets. As a result, many pets are taking psychiatric medications.
"I think the increased use of psychoactive drugs comes from acceptance, even in the scientific community, that it's okay to talk about fear, stress and anxiety in animals," said Carlo Siracusa, a clinical assistant professor of behavior medicine at the University of Pennsylvania School of Veterinary Medicine.
Whether pets really need these mood-altering drugs remains controversial. Nicholas Dodman, a professor emeritus at the Tufts University Cummings School of Veterinary Medicine and author of the book Pets on the Couch, has written that animals experience behavioral disorders similar to those of humans and that pets may need medications to alleviate their suffering. Treating these conditions, Dodman says, might also prevent some pets with behavioral issues from being sent to shelters or from being euthanized.
Siracusa said that the use of psychiatric drugs in veterinary medicine represents a shift away from poorly regulated "punishment-based behavior modification" such as shock collars for dogs that bark too much. "If you have to use a psychoactive drug, you have to talk to a vet, right?" he said. "If you have to use the shock collar, you just go on Amazon and buy it yourself," he said, adding, "The psychoactive drug is probably more benign of all the possible terrible things that [people] could do to animals when [they] don't like their behavior."
There is at least some published evidence to support treating pets with psychiatric drugs. In particular, randomized, placebo-controlled trials suggest that antidepressants may help dogs suffering from separation anxiety or compulsive behaviors such as tail chasing.
But several of these studies received some funding from the pharmaceutical companies marketing these drugs to veterinarians and pet owners. These studies also frequently showed mixed results or included behavioral therapies as part of the treatments for animals.
Critics of giving pets psychiatric medications argue that owners should rely more on behavioral approaches, such as spending more time with pets, taking them outdoors and using training programs. Research supports the notion that environmental factors probably play a role in the development of behavioral issues in pets.
Perhaps unsurprisingly, studies suggest that dogs who are walked only a few times each week or whose owners spend less time at home may be at greater risk for behavioral problems, such as excessive barking and destructiveness.
Still, there are situations that seem to warrant treating pets with psychiatric medications. For instance, veterinary staff often suffer injuries such as lacerations and bites from agitated animals. Under these circumstances, veterinarians may turn to such medications as acepromazine - a medication similar to chlorpromazine, the first antipsychotic widely used in humans - to help sedate aggressive pets.
Giving these kinds of drugs to pets isn't risk-free. Just as with humans, psychiatric medications for pets can carry plenty of side effects, including gastrointestinal upset, weight changes and irregular heartbeats.
The overlapping use of psychiatric medications among humans and animals also raises the specter of owners sharing drugs with their pets. Veterinarians have voiced concerns about owners using pets to obtain access to restricted drugs, including anti-pain opioids and anti-anxiety benzodiazepines.
Veterinary organisations are establishing frameworks to guide the use of psychiatric drugs in pets. In 2015, the American Animal Hospital Association published practice guidelines for the behavioral management of cats and dogs, including recommendations regarding when medications may be helpful to these animals.