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A veterinary blog for pet lovers, vet voyeurs and the medically curious...
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Last night on NPR you may have heard a report on the over-diagnosis of bipolar disease in humans. Hearing the psychiatrists decry the increasingly ready use of this terminology to describe many merely depressed patients, I couldn’t help but think about how this over-diagnosis (and over-medication) applies to pets.
After all, drug companies are increasingly targeting pets in their drive to expand the market for psychotropic drugs like Reconcile (fluoxetine, essentially Prozac) and Clomicalm (clomipramine). Elavil (amitryptilline), Paxil (proxetene), Anipryl (selegiline) and Xanax (alprazolam) are also frequently employed in pet medicine for behavioral (AKA, mental) illnesses.
The NPR report’s interviewees pointed the finger at both overzealous drug companies and physicians’ shoddy diagnostic practices. Drug company seminars have allegedly exhorted that physicians of all stripes (not just psychiatrists) recognize the symptoms of bipolar disease. And physicians, easily influenced by their claims (and not wanting to fail to diagnose a disease that can kill) have overreacted.
Though it may be an oversimplification to claim that 1) bipolar disease is indeed being over-diagnosed (some clinicians simply consider the condition to incorporate more than just the manic depression previously considered the hallmark of the disease) and 2) drug companies are big bad meanies skewing our perception of diseases just to make a buck, it’s clear that when it comes to drugs for mental illness there’s a big concern that it’s too easy to mis-medicate.
The same may well be true for pets. As with humans, it’s too often difficult to distinguish whether beating a disease into submission is the same as treating symptoms. In that sense, depression (and bipolar diagnoses in its wake) may be no different than the anxiety (and its many sub-categories of diseases) we veterinarians treat with psychotropic drugs.
In pets the big question always lingers: When are we truly treating a disease and when are we simply masking symptoms in a drive to curb natural behaviors owners are unwilling or unable to control?
The same question applies to children and the elderly in the human population as for pets: Is over-diagnosis or misdiagnosis the side effect of convenience-based diagnostics?
And while it’s horrible to think that people are being treated for diseases they don’t have, with medications that may hurt them, at least someone’s paying attention to their mental health, something which twenty years ago might have been overlooked entirely. When we know that diseases of depression kill people daily, perhaps it’s something of a comfort to know that we’re moving in the right direction.
In pets that’s doubtless the case as well. Though in many ways vets have more roadblocks in establishing diagnoses than human docs do (little research, poor client compliance when it comes to training, low acceptance of referrals to veterinary behaviorists), we’re getting better at it every year.
And though it’s popular to come down on the side of corporate malfeasance, at least the drug companies are doing research into the behavioral conditions there seems we have no money to fund otherwise.
It’s for that reason that veterinarians get more of a pass when it comes to treating animal behaviors with a pharmaceutical cudgel. After all, when the alternative is the shelter, what’s a vet to do?
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"The greatness of a nation can be judged by the way its animals are treated."
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- Mohandas Gandhi
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If I had a nickel for every time I noted a behavior change, far in advance of the obvious symptom, I'd certainly have a few bucks. Owners, including myself, cannot always describe well enough or perhaps it is so vague and intermittent---that a typical exam may not reveal a cause.
And then there are the "mental wrecks" , that no drug is going to undo in a magic instant---for the pets that may have been abused or neglected.
My concern stems from the many stories I've been told regarding hasty euthanasias in a breed (Sealyham) that can manifest pain in unpleasant ways, much to the more typical Scottie "Die-hard" breed that will almost never exhibit pain overtly.
My fear is that vet medicine will turn into the new big pill pushing fad. Yes there are cases when meds are necessary, but seeing how there are now doggies weightloss pills, I have my doubts. Vets are people and lots of people think pills are a cure for everything...
This comment is directed at you specifically Dr. Patty. I was talking about vet medicine in general.
On the other hand, my dog was put on a drug for collapsing trachea, which seemed harmless at the time, but long term use almost led to him being put down when he developed nervous symptoms and was terrified of everything. Took some diagnosing too, since I did not suspect a medication he had been on for four years, but luckily a vet finally did.