Treatment of behavior problems in cats

Many people think cats are great pets because they are relatively self-sufficient. If we provide them with the basics - a clean litter box, fresh water, and access to nutritious food - they live with us without requiring constant care. However, that same advantage can sometimes create problems when circumstances are unfortunate. If a cat develops a behavior problem, owners are often at a loss as to how to solve it.

As with dogs, many behavioral problems in cats can be solved by changing the way the cat is cared for or the environment. For example, problems with the litter box can often be solved by changing the litter box, litter, or other factors associated with the use of the litter box. Scratching in inappropriate places can be addressed by providing the cat with appropriate scratching surfaces, and excessively noisy play can be transformed into an acceptable activity.

However, sometimes cats develop behavioral problems that owners are unable to reduce or resolve. For example, problems may arise between multiple cats in a household, a cat may stop using the litter box due to a medical condition that doesn't bother it anymore, or a cat may over-groom itself, causing all of its fur to fall out.

When cats have behavior problems like these, trained professional animal behavior experts can help. After considering all the specifics of your cat’s behavior problem and all the factors that influence it, a behavior specialist can develop a successful behavior modification plan to resolve the problem. In some cases, a behavior problem can be treated most successfully with a combination of behavior modification and medication.

Are medications necessary?

You may not want to give your cat medication and would prefer to find a solution that focuses on changing your cat’s behavior or environment. However, remember that some problems can be resolved more quickly and with less stress for you and your cat if medication is included in the treatment plan.

The most effective approach to treating a cat's behavior problem is behavior modification. Behavior modification plans developed by competent, qualified professionals address behavior problems in the following ways:

• Changes in the cat's perception of a situation or object
• Changing the consequences of cat behavior
• Providing the cat with an acceptable outlet for its natural behavior or an opportunity for acceptable behavior in place of the problem behavior
• Using a combination of these solutions

Unfortunately, changing behavior can be difficult in some situations. For example, a cat's natural behavior is sometimes incompatible with its environment. Many modern homes have multiple cats. But cats are solitary hunters, and while they sometimes get along, it is also normal for them to avoid each other. Since living together is not natural for them, it is sometimes necessary to help cats living in the same home learn to accept each other. This can be accomplished through a behavior modification procedure called desensitization and counterconditioning. However, sometimes cats are so agitated and upset by each other's sight and smell that this procedure is not possible. In these cases, a behavioral medication can reduce the cats' reactivity to each other, and the procedure can be carried out successfully.

Can medication be used instead of behavior modification?

Usually, behavior modification alone is not enough to solve behavior problems. Medication serves to reduce the emotional component of the situation, but it does not address the behavioral component. While medication controls the cat's emotional reactions, behavior modification is used to change the cat's behavior. For example, if your cat is afraid of another cat in the house, it may not use the litter box because of its fear. Medication may help the cat become less reactive to the other cat, but it will not help train it to use the litter box again.

Which drugs are best in which situations?

There are four types of drugs that are primarily used to treat behavioral problems in cats: benzodiazepines, monoamine oxidase inhibitors, tricyclic antidepressants, and selective serotonin reuptake inhibitors.

The following table shows various behavior problems in cats that have been successfully treated with a combination of medications and behavior modification:

Behavior problem	Type of drug
General timidity	Selective serotonin reuptake inhibitor, tricyclic antidepressant
Litter box problems caused by anxiety	Benzodiazepine, tricyclic antidepressant, selective serotonin reuptake inhibitor
Urine marking	Benzodiazepine, tricyclic antidepressant, selective serotonin reuptake inhibitor
Aggression	Benzodiazepine, tricyclic antidepressant, selective serotonin reuptake inhibitor
Obsessive behavior such as excessive grooming	Selective serotonin reuptake inhibitor, tricyclic antidepressant
Cognitive dysfunction	Monoamine oxidase inhibitor

Drugs for the treatment of sudden severe fear and aggression

Antibiotics need to be given for a while before they start to fight bacteria. The same is true for medications for behavior problems in cats - they need to be given daily for several weeks before they start to show results. In situations where a cat is aggressive at the slightest sight or smell of another cat or has other severe reactions to fear of something else, waiting several weeks may be too much. Benzodiazepines can reduce a cat's reactivity immediately. Benzodiazepines work immediately after administration, so they can help control fear or aggression within a few hours.

Some common benzodiazepines include diazepam (Valium®), alprazolam (Xanax®), chlordiazepoxide (Librium®), lorazepam (Ativan®), and clonazepam (Klonopin®). Benzodiazepines work by increasing the activity of a chemical in the brain that prevents fear circuits from being activated.

Dose effect

You can only know if a medication is working if you understand what effects to expect. The following list shows expected reactions in cats to different doses of benzodiazepines:

• Small doses of benzodiazepines reduce the intensity of excessive behavior and decrease excitability.
• Moderate to high doses of benzodiazepines may reduce anxiety and increase playfulness, but may also cause movement and thinking disturbances, including disorientation. Benzodiazepines affect some of the same parts of the cat's brain cells as alcohol does in the human brain, causing similar effects. High doses may increase anxiety and restlessness, especially if the animal is already depressed when taking the drug.

Side effects

Benzodiazepines may increase appetite and insomnia. They may also have a negative effect on learning and memory, so they are not suitable for long-term use with desensitization and counterconditioning.

Impact on health

Benzodiazepines are metabolized in the liver and excreted by the kidneys, so if your vet advises you to treat your cat with benzodiazepines, they should check your cat's liver and kidney function and do a simple blood test. If your cat has had kidney or liver problems in the past, be sure to let your vet know.

Medications for the treatment of long-term behavior problems

Behavior problems that involve daily household issues, such as conflicts between multiple cats in a household, or long-term problems such as excessive grooming are best treated with long-term medications such as tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors.

Tricyclic antidepressants

Tricyclic antidepressants were first used to treat depression in people. They work primarily by increasing levels of serotonin and norepinephrine, neurotransmitters involved in regulating emotional activity. They also affect other neurochemicals involved in emotional reactivity. The tricyclic antidepressants most commonly prescribed for cats include amitriptyline (Elavil® or Tryptanol), clomipramine (Anafranil® or Clomicalm®), doxepin (Aponal®), imipramine (Antideprin® or Deprenyl), desipramine (Norpramin® or Pertofran), and nortriptinyl (Sensoval). Each cat is unique in its behavior and physiology, so one tricyclic antidepressant may not work while another may work well.

Although tricyclic antidepressants were originally used to treat depression in humans, they can also reduce anxiety, combat obsessive behavior, and help irritable people. They have been used successfully in cats to treat obsessive behaviors such as excessive grooming, reduce reactivity to other cats in the home, and treat anxiety.

Application scheme

Tricyclic antidepressants are intended for daily use. If you do not take the drug every day, it will not be effective. Tricyclic antidepressants usually do not work on the first day or even the first few days of use. Because at least part of their effectiveness depends on the changes they cause in the brain, tricyclic antidepressants must be taken for at least 2 to 3 weeks before results are seen. Treatment must continue for at least two months before a conclusion can be made about the effectiveness of the drug.

Impact on health

Tricyclic antidepressants are metabolized in the liver and excreted by the kidneys of the cat, so if your vet recommends treating your cat with tricyclic antidepressants, he or she should do a simple blood test to make sure these organs are working well before starting treatment. If your cat has had any kidney or liver problems, be sure to let your vet know. It is recommended that you repeat the blood test annually (twice a year for older cats) to make sure the drug has not damaged the liver or kidneys.

Tricyclic antidepressants should not be used with monoamine oxidase inhibitors because combining the two types of drugs can increase serotonin to unhealthy levels.

Side effects

Tricyclic antidepressants can increase swelling, and swelling causes dry mouth. As a result, cats may foam at the mouth and become very thirsty. They may drink more water than usual because of thirst. Water retention can also lead to constipation and even diarrhea. These problems can lead to bowel movements/urination in inappropriate places. Tricyclic antidepressants can also cause a sudden increase in heart rate.

Monoamine oxidase inhibitors

Monoamine oxidase inhibitors act on similar neurotransmitters as tricyclic antidepressants, but act in a different and less selective manner, so they have a more general effect on the brain. Selegiline (Anipril®) is a monoamine oxidase inhibitor that appears to act primarily on the neurotransmitter dopamine. It is used to treat cognitive dysfunction in older cats, and research suggests that it may slow brain aging.

Impact on health

Some monoamine oxidase inhibitors have dangerous side effects if the patient eats cheese. Selegiline does not fall into this category, but because some people have reactions to cheese while taking the drug, owners should not give their cats cheese while taking selegiline.

Monoamine oxidase inhibitors should not be used with selective serotonin reuptake inhibitors because combining the two types of drugs can increase serotonin to unhealthy levels.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) affect a chemical in the brain called serotonin. Common SSRIs include fluoxetine (Reconcyle® or Prozac®), paroxetine (Paxil®), and sertraline (Zoloft®).

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and sertraline, have been used successfully in the treatment of a number of anxiety-related behavior problems, such as litter box anxiety, fear of other cats in the household, or aggression directed at other cats. SSRIs are also effective in treating compulsive behaviors, such as excessive grooming.

Impact on health

SSRIs are metabolized in the liver and excreted by the kidneys. Even if your veterinarian does blood work to check the liver and kidneys before starting treatment, be sure to tell him about any medical conditions your cat has or has had in the past. It’s a good idea to have your cat’s liver and kidneys checked annually if she’s taking an SSRI.

Selective serotonin reuptake inhibitors should not be used with monoamine oxidase inhibitors because the combination of the two types of drugs can increase serotonin to unhealthy levels.

Application scheme

SSRIs must be given daily to be effective. If the drug is not given daily, it will not be effective. SSRIs are rarely effective on the first day, and may actually increase anxiety in some cats before a therapeutic effect occurs. Because SSRIs cause changes in the brain, they must be given for at least six weeks before a response is seen. Treatment should be continued for at least four months before a conclusion can be made about the effectiveness of the drug.

Because SSRIs take several weeks to work, some people also treat their cats with other drugs, such as a benzodiazepine, when starting treatment.

Serotonin receptor agonists (5-HT)

Buspirone (Buspar® or Bespar) is the only serotonin receptor agonist that is routinely used in behavioral treatment plans for pets. It is sometimes used in combination with selective serotonin reuptake inhibitors and tricyclic antidepressants at the beginning of treatment, but is also sometimes used alone.

Application scheme

Like other drugs that affect serotonin, buspirone must be taken daily to be effective. If the drug is not taken every day, it will not be effective. The therapeutic effect of buspirone usually appears after about three weeks, although this period may be shortened if the drug is taken in addition to a selective serotonin reuptake inhibitor.

How to give medicine to a cat

If you decide to use medication to help your cat with a behavior problem, you may encounter difficulties in giving your cat the medication. Sometimes it is difficult to get your cat to swallow pills, and some cats become so upset that they avoid their owners. To learn how to give your cat medication so that it is as upsetting as possible, read the article “How to Give Your Cat Medication.”

Seek advice from an experienced professional

This article is intended to help pet owners understand common medications used to treat behavior problems in animals. It is not a guide to choosing a medication. If your cat suffers from fear, anxiety, obsessive behavior, or another behavior problem and you want to put your cat on medication, be sure to consult with a certified animal behaviorist first. A qualified animal behaviorist can evaluate your cat's problem and help create a treatment plan, advise on medications, and work with your veterinarian to maximize the success of the treatment program.