Cat Anxiety, Aggression & Medication with Dr. Sagi Denenberg

Cat aggression, overgrooming, and litter box “problems” are easy to label and surprisingly hard to solve, especially when we treat the behavior as the diagnosis. We sit down with veterinary psychiatrist Dr. Sagi Dennenberg to get underneath the label and into what’s actually driving the cat’s behaviors: fear, anxiety, frustration, learned patterns, pain, and even underdiagnosed skin disease.

We talk about why behavior and physical health are inseparable in cats, including how stress can skew vital signs and lab results and why “my cat is not herself” can be an early warning sign before anything obvious shows up on an exam. Sagi explains what a true behavioral diagnosis looks like, why home observation and video can reveal subtle pain, and how clinicians can avoid the trap of calling something “psychogenic” too quickly.

Then we demystify psychoactive medications for cats. We cover what meds can realistically do (normalize biological behaviors and lower emotional intensity) and what they cannot do (teach skills or replace behavior modification). You’ll hear how diagnosis guides medication choice, what to expect from SSRIs like fluoxetine, how to think about timelines and tapering, and why many “side effects” are actually a return to normal sleep and eating patterns. We also get practical about dosing challenges, including when transdermal medications may help and when they can backfire, especially in multicat homes.

If you’ve felt unsure about cat behavior meds, worried about side effects, or stuck with an ongoing behavior issue, this conversation will give you a clearer framework and more confidence in your next steps. Subscribe for more, share this with a fellow cat person, and leave a rating or review so more listeners can find the show.

Transcript

Cold Open And Guest Preview

Kristiina Wilson 0:00

Welcome to another episode of His and Tell. Today I am joined by veterinary psychiatrist Sagi Denenberg for a conversation about feline behavior, psychoactive medications, stress, aggression, and the myths that still shape the way that we all think about cats. We are going to talk about behavioral diagnoses, why behavior and physical health are so deeply connected, and how medication can help cats. If you've ever been confused or hesitant about behavioral meds for cats or wondered what's really going on beneath behaviors like aggression or over-grooming or even house soiling, this episode is for you.

Meet Veterinary Behaviorist Sagi Denenberg

Kristiina Wilson 0:50

Welcome, Sagi. Thank you so much. Thank you so much for being on the podcast. I wanted to start off by saying that your paper, Tools for Managing Feline Problem Behaviors and Psychoactive Medications, that came out in the Journal of Feline Medicine and Surgery in 2018, has been sort of like a Bible for me in my practice and something that I like to send to clients who are a little bit on the fence or don't really understand how psychoactive medications work. So that is a huge reason and a big part of why I wanted to talk to you today because I think there is a lack of knowledge just kind of generally about psychoactive medications and felines and how they work in the brain and the benefits of them and the drawbacks. So I am really glad that you agreed to be on the podcast and that we can have a bit of a chat about it. So can you start by just telling me a little bit about yourself, what you do, how you got into what you do? It's been that long since 2018. I know. Isn't it crazy? It just seems like a couple years, and then you realize it's been eight years.

Sagi Denenberg 1:52

Wow.

Kristiina Wilson 1:53

I know.

Sagi Denenberg 1:54

Yeah, no, it just uh you said 2018. I said, wow.

Kristiina Wilson 1:58

I know, it's crazy.

Sagi Denenberg 1:59

Well, I have way more white hair, so I guess that says something. Right. So I'm a veterinarian. I studied veterinary medicine in Slovakia. But originally I'm from Israel. I studied in Slovakia, then I moved to Canada where I pursued my residency in veterinary behavioral medicine. I became board certified by the American College of Veterinary Behavior, the European College of Animal Welfare and Veterinary Behavior, and I'm also a member of the Australian and New Zealand College of Veterinary Scientists in the animal behavior chapter. I've been working in Canada since then, doing my clinical practice. Then I moved to the UK, where I lived for three years, working there, teaching at the University of Bristol and doing clinical cases, and after three years, I moved back to Canada. Since then I'm here in Toronto, I've been doing clinical practice, but alongside that I've been teaching and working at the University of Bristol. I've been traveling back and forth, back and forth on a monthly basis to do cases there and to mentor residents. And then my resident took over the case lawdale. I have other residents that I mentored, both elsewhere in Canada and here, and I have residents in Australia. And I'm also teaching at the University of St. Matthews in Grand Cayman. And that I'm involved in research for my residence. I'm involved in writing. I have my own book, the textbook of small animal psychiatry. And mostly I see clinical cases of dogs and cats.

Kristiina Wilson 3:36

All right. Thank you. That's that's so interesting, and that's so much travel. You must be really racking up the mileage points.

Sagi Denenberg 3:43

Less now. I'm trying to reduce, but certainly I have been.

Kristiina Wilson 3:46

Yeah. Boy, do you find that there are more veterinary behaviorists in Canada or in England than there are in the US? Because I know we don't have very many

Why General Vets Miss Behavior

Kristiina Wilson 3:56

of them here.

Sagi Denenberg 3:57

No, I think that uh when you look at bold certified veterinary behaviorists, the US has the most. We don't have a whole lot as to begin. Okay. The American College of Veterinary Behaviorists, the last time I checked, has about 120 diplomats.

Kristiina Wilson 4:14

Yeah.

Sagi Denenberg 4:15

Maybe a few more now. And the majority of them are in the US. In Canada, we have myself and another one in Ontario. We have five in Quebec, two in the uh maritime provinces, and one in Alberta, that's it. In the UK, there are only four or five, if you include me, when I'm there. Right. Yeah.

Kristiina Wilson 4:40

Boy. So for listeners who may not understand what the difference is between a behaviorist like myself and a veterinary behaviorist. A veterinary behaviorist is obviously a vet who is all additionally boarded in behavior, right? So how much extra schooling is there on top of your veterinary schooling?

Sagi Denenberg 4:58

Well, when it comes to animal behavior and the professional that play a role there, there are actually three tiers, if you'd like.

Speaker 3 5:04

Right.

Sagi Denenberg 5:05

Or possibly four. There are trainers who primarily engage with basic obedience, setting up daily routines and things like that. Then there are animal behaviorists that usually pursue more knowledge, more information, more continuing education. Right. And they focus more on behavior modification and counterconditioning. And then there are veterinary behaviorists who do that, but they're also veterinarians first.

Speaker 3 5:31

Right.

Sagi Denenberg 5:32

So the main differentiation is the ability to diagnose and manage physiological disorders contributing to emotional and mental disorders, and the ability to prescribe medications. So whether it's gastrointestinal abnormalities or skin abnormalities or pain-related behaviors that contribute to medical problems, cognitive decline in dogs and cats. Like I said, prescribing the appropriate medication. So essentially the veterinarian first finished veterinary school, and on top of that, they had to pursue residency that takes anywhere between three to five years, depending on the intensity and where you do it. Following that, um, you would have to publish a research. You would have to publish a case report, and then you sit for an examination that takes two days. And once you complete all of those criteria, pass the exam, then you become a board certified veterinary behaviorist.

Kristiina Wilson 6:26

Okay. Interesting. Something that I've noticed a lot in dealing with my clients is that a lot of their regular vets know very little about behavior. Because I think because they're going through so much about just learning about all the different animals that they have to deal with in their practice. How much do you think that just a regular vet is learning about behavior in their education? And do you feel that there needs to be more? Because just more and more I find that obviously these cases tend to be intertwined between physiological drivers and behavior drivers. They're not often independent of each other, just like you were saying.

Sagi Denenberg 7:04

It is a sore spot for sure.

Kristiina Wilson 7:07

Yeah.

Sagi Denenberg 7:08

And I think that when you talk to any specialist, they will tell you that their specialty is the most important and students should spend most time on it. And I'm no different. Well, I am different because I'm right and they're wrong. And the reason that I'm right and they're wrong is that when you look at the general practice, so when students finish veterinary school, they go and they start working in general practice. If you break it down to disciplines and then you see the frequency of what they see in day-to-day, so they may see neurological disorder once a week. They may see orthopedic disorder, pain-related problem three, four times a week. They may see skin problem or gastrointestinal problem four or five times a week.

Speaker 3 7:55

Right.

Sagi Denenberg 7:56

Or maybe even once a day. But behavior they see every day, all day.

Speaker 3 8:01

Yes.

Sagi Denenberg 8:02

Because it starts with the fact that the animal are afraid to come to see you. And it's about identifying the body language when you handle the animal. It's about knowing how the animal feels. And it's the impact that it has on your finding because you take blood pressure, you take blood sugar, you take heart rate, you take temperature. Those would be completely different when the animal is relaxed versus non-relaxed. And you need to be able to identify that to say, okay, I did take a high blood sugar, but you know what? The animal was really stressed. So it's probably not diabetes, it's probably just the stress. And there are many diseases that are nicknamed and vets use that all the time without actually paying attention to what they are saying. They call it stress hyperglycemia.

Kristiina Wilson 8:46

Yes.

Sagi Denenberg 8:47

Or they call it stressed colitis. And they completely ignore the word stress there. So certainly it's something that just by percentages you see a lot. And it's also important to remember that in many cases, the first and sometimes the only sign of a physiological abnormality is a behavioral change.

Speaker 3 9:09

Right.

Sagi Denenberg 9:10

I remember when I did my residency uh 20 years ago, I used to work in an emergency clinic here in Toronto with our winters, and you have people come in at 2 o'clock at night, driving through a blizzard, risking their life, driving to the clinic at 2 o'clock at night, and you ask them, you examine the animal, you ask what's wrong, you say, oh, my dog is not itself. My cat is not herself. And when you examine them, there is nothing that you can pick up on a physical examination. There is, you do the physical examination, maybe you even run a blood test, and nothing comes out. And you start thinking, why are you here in the middle of the night for a blizzard paying emergency fees when there is absolutely nothing wrong with your animal? But doing that for several years, for quite a few years, actually, it taught me one thing. Trust the owner because they know that their pet's behavior changed. They may not be able to tell you what changed, but they know it changed. They realize that and they tell you something is not wrong. And sure enough, you give it two, three days and something shows up. Even if you weren't able to pick it up. And that's what vet students don't get enough of. They don't get enough of understanding how behavior changes. And even if you can't see it at the moment because the animal is stressed, you need to look for other signs. And like I said, I teach behavior at, well, I taught behavior at the University of Bristol, and I'm teaching at the University of St. Matthew's, and some other universities start adding more and more to that. But unfortunately, the vast majority of vet students don't get enough behavior and they move on to the world without knowing how to identify behavioral problems. And it's not just that, it's also the risk for them and for their staff and for the owner at the clinics. And it's also the risk for an animal, because unfortunately, many times we work with sharp objects next to the animal, whether it's a vaccine or blood collection or even a nail train. And if this animal starts flailing, if the animal suddenly jerks, we can hurt them with those things. And if you identify those behaviors in advance, if you identify those telltale signs, you know how to avoid that. You know how not to put yourself, your staff, and the owner and the animal at risk. Or how to manage an animal that is dangerous, or not just dangerous, but afraid of you.

Speaker 3 11:27

Right.

Sagi Denenberg 11:28

So I don't think vets unfortunately know enough. And to top it all, there is a lot of misunderstanding and myths about animal behavior, the whole dominant myth, or this myth, or that behavior, or that behavior. And there are wrong ways of handling animals, and unfortunately, some are still taught how to restrain an animal. Yeah. And many of those are wrong and they make it worse. So as you can see, it's quite a sore spot. But we're working on it and it's getting better.

Dominance Myths And The Alpha Problem

Kristiina Wilson 11:56

Yeah, I agree. I'm I'm glad to see more and more vets becoming fear-free practices. I know it's a slow, a slow, uh, a slow change, but it's nice to see. And but I agree that that wolf paper that in the from the 70s that was then you know retracted within a year that started the whole dominance theory issue.

Sagi Denenberg 12:17

Well, that actually started earlier, and there is a great video clip on YouTube. This video clip is about nearly 20 years old. It's made by David Mesh. L David Mesh, M-E-C-H. David Mesh was one of the pioneers of wolf behavior research.

Speaker 3 12:35

Right.

Sagi Denenberg 12:36

And he started in the late 50s, early 60s. He studied them. He's a Canadian, he started studying them here in Canada, and he also studied them in reservation and other places around the continent. And he there is a video that he sits, he looks like Santa Claus sits in front of his fireplace in that video, and he talks to the camera, he sits on his armchair. Very nice video clip. But the video clip starts like that. I'm the one to be blamed for the wrong use of the term alpha. Oh no. David Mesh coined the term alpha, and he came with the dominance theory in wolves. But that was in the 60s, where the technology was not as well as today, and the finances were not as good as today. So they studied wolf in zoos and in captivities. Whereas today, when you study them in their natural habitat, you see that it's completely flawed, the whole dominance theory. And not to mention that dogs are not wolves. Dogs are being where they were domesticated for 50,000 years, cats for about 6,000 years, they're completely different by domestication than their wild counterparts. So those, even if that was applying truly, which is not to the wild canine, it certainly does not apply for the domestic canine or the domestic feline.

Kristiina Wilson 13:50

Right.

Sagi Denenberg 13:50

Unfortunately, people still stuck 6,000 years ago.

Kristiina Wilson 13:53

I know. I think also the problem is that when something gets fixed and put out there kind of into general knowledge, especially online, it's so hard to get rid of it. You know, I see in my client histories so many things in the histories talk about following these really incorrect and outdated and old protocols that are just 180 degrees the wrong way for doing things for their cats for introductions and for working on aggression. And it's just because if you Google how do I get my cats to get along or how do I do this, you get all of these really old, outdated things. It's so hard to get new information to saturate the market, as it were.

Sagi Denenberg 14:30

And then well, and on top of that, you still have people who still believe in it. So you said old and outdated. I would argue that it's not old, it's just outdated. Many people still use it.

Kristiina Wilson 14:41

I'm trying to be nice, trying to be nice and not get too much into this. Is one of the topics that I can get really heated about and get mad at people who are still out there putting this not updated people who are not doing continuous.

Turning Aggression Into A Diagnosis

Kristiina Wilson 14:57

So, can you walk me through a little bit what a behavioral diagnosis looks like in cats? You write a lot about how behaviors like aggression or just urine spraying are not diagnoses.

Sagi Denenberg 15:12

There is a difference between describing the behavior. Aggression is a description of a behavior. Aggression is a behavior the animal is using when it fits the context. A cat that is hunting, that's by far the worst aggression you can see because the purpose is to kill and eat. When people see cat hunting, they don't say bad cat.

Speaker 1 15:34

Right.

Sagi Denenberg 15:35

They say a hungry cat. A queen protecting her kittens. Is she a bad cat or is she just a good mother?

Speaker 3 15:44

Right.

Sagi Denenberg 15:45

But it's still aggression.

Speaker 3 15:46

Yeah.

Sagi Denenberg 15:47

So aggression is a tool. So to describe a cat as being aggressive doesn't give you the information that you need in order to treat the problem. It just labels the cat as this is the behavior the cat is doing, but it gives us very little data to work with. So the descriptive diagnosis, sibling rivalry, aggression towards family member, aggression between two cats, it's just a label. It doesn't really help us. So it's about underlying motivation. It's about the emotions or mental or cognitive processes in the brain that lead to aggression. That could be anxiety or fear or frustration. And sometimes it's a physiological condition like pain or irritability of the skin, and I don't want you to touch me, for example, or compulsive behaviors and so on. Sometimes it's purely learning. It has nothing to do with emotional disorder, nothing to do with mental disorder or with physiological disorder. It's just learning. I know that if I show aggression, you leave me alone. Perfect. It works. I'll keep using that. That's the right tool for the job. So making diagnosis requires you to start looking at patterns of behavior, not just tell me what your cat is doing. You want to see if there is a repetitive nature to it, if there are any triggers there that repeat themselves. Many times owners will tell you, I don't know why it happened, because the triggers could be historical.

Kristiina Wilson 17:10

Yes.

Sagi Denenberg 17:11

So it's important to delve a little bit into the history to see what's going on there. And it's important to look at what's going on now, what the owner was doing in the past to manage it, what the owner is currently doing, how the cat responded or responded in the past to that. And of course, on top of that, there is a need to do a full physical examination.

Speaker 3 17:31

Right.

Sagi Denenberg 17:31

And there is a need to have more observation done at home. Because when I do a physical examination, first, many of my patients are not amenable for physical examination because they're afraid and they're aggressive. So skews the result. Second, if I touch an animal and say I'm trying to bend the knee or bend the hip to see if there is any pain or press on the back or anything like that, and the animal reacts, whether it's yelping, crying, hissing, running away, trying to scratch me, how do I know if this cat is in pain or afraid? Right. They don't tell you. So a lot of that is also telling an owner, you need to follow at home. Now it's not that we just leave them to follow like that. We give them pointers. I want you to look at how your cat jumps on and off. I want you to see how your cat goes up and down the stairs, any difficulties moving, any hesitation, using four feet independently. Now, when I say observe, usually we say get videos.

Speaker 3 18:27

Yep.

Sagi Denenberg 18:28

Because then you can slow it down, you can watch different body parts, you can watch it several times. And you see that because some of those behaviors are so fast and they are so short. For example, a cat that jumps off the counter onto the floor, supposed to land with both feet, front feet equally, and bend the elbow no more than about 60 degrees. But sometimes you see the cat landing with one foot first and the other. So say maybe just landing left first and then right. And I'm talking about a split-second difference. Left, right, left, right. You don't see that live, but when you see that in the video, you can see that the left one always leads. So that right one might be more sensitive. That's why the cat is using more the left. Or if the angle of bending the knee, the elbows, is more than 60 degrees, which you don't see in real life, you have to slow it down, you have to measure. That tells you that there is weakness, so the cat has to lean more to the point where they almost hit their chin, landing on the surface. So there are subtle things like that. So when we suspect that we say, okay, you need to go home, you need to get videos because me touching your cat at the clinic, they're afraid, they may respond to that, not to pain. And plus, we don't see full range of behavior. Sometimes I have cats that go out of the carrier and hide under the sofa the entire time.

Speaker 3 19:45

Yeah.

Sagi Denenberg 19:45

At home, when we don't touch them, you remove the fear element. And if you still see deficits, it's probably pain.

Speaker 3 19:53

Right.

Sagi Denenberg 19:54

Or if an owner says, Look, my cat scratches a lot, and they think it's psychogenical opecia, which we know that about 76% of those are not, they're a physiological condition. A colleague of mine here in Toronto, Steve Weisglass, did a study about it back in 2006 where he found that most cats that refer to behavior with excessive grooming were actually underdiagnosed skin disorder, even though the vet was convinced that it was uh psychogenic. The vet said, I did everything. It's not physiological, it's psychogenic. And he still found out that 76% of them were purely medical. So we tell owner, you need to go home, you need to keep a diary. When is your cat scratching? How often? Will it stop when you tell them? And so on. And then we get patterns, and then we can start ruling out. Of course, sometimes you have to do your physical exam, whether it's a skin scraping and trichogram, when you look at the hair under the microscope to see if the hair is broken, meaning the cat pulled it or the hair just fell as a home piece and then it's not leaking. You may need to do x-rays or blood tests, and of course, urine tests if there is any house soiling. So we have to do all of that. But once we collect all of that information, the physical exam, any laboratory testing that may be required, and maybe more information later from home, now we can complete the picture. Now we can have a diagnosis. Not always we reach a diagnosis because sometimes there could be several things intertwined, which makes it more complicated. Having skin disorder doesn't rule the fact that the cat may do that also because of stress. So we have to look into all of that. And sometimes it's presumptive diagnosis where you treat that presumptively and you see if your treatment is working, at least you are in the right direction.

What Psychoactive Meds Can Do

Kristiina Wilson 21:40

Yeah. No, you are preaching to the choir. I am the biggest fan of cameras. So you wrote a lot, as I said, about medication. Can you talk a little bit about what medication can realistically do and what it can't do?

Sagi Denenberg 21:53

So there are a few things to remember about the medication before even going to specifics. Medications don't Change behaviors. Right. Medication will not solve the problem. Medication will not make the cat happier or teach them what to do or say, don't do this. This is all the owner through training and behavioral modification and environmental management and routine changes. The way I look at medication is it's a concierge. It opens the door for you to go through and do the job that you need to do. It's not instead of anything. That's very important to remember. Now, what medications actually do, most medications that we use, they balance neurotransmitters, different neurotransmitters, serotonin, adrenaline, dopamine, gamma aminobutyric acid, and so on. And that's the important point. You need to get your diagnosis because when you get your diagnosis and you say, right, that's an anxiety, then you start thinking, okay, if it's anxiety, I need to balance serotonin. If you think it's frustration and high arousal, maybe I need to balance serotonin and adrenaline. So once you get your diagnosis, it tells you what neurotransmitter you need to work with, and then you can choose the right medication. Our medications are exactly that: SSRI, selective serotonin reaptic inhibitors, or there is SNRI, serotonin and noradrenaline reaptic inhibitor, or dopamine reaptic inhibitor, or medications that control gamma aminobotyric acid or GABA, like the benzodiazepine, the valin type medications. So you need to know your diagnosis in order to choose the right medication. If you don't know, you just pretty much for medication. When I have a vet calling or asking what medication do you have for house soiling, I say, I don't have medication that will teach to go to the litter box. Tell me what's your diagnosis, tell me what's the underlying emotion, then I can tell you what is the problem. Now, that's the way it should work, and that's the way it's truly working. But there is a there is a little bit of a shocker. There is a cheat sheet here. Given that we are dealing with emotional and mental disorders, the single most important neurotransmitter that plays a role in almost all of them is serotonin. So choosing an SSRI, selective serotonin reaptic inhibitor, is usually a good starting choice, even if you're not sure exactly what's going on. So that's a call it a small perk that we have. Sure. But ultimately you need to know what are your diagnoses, and then you tailor your medication to that.

Speaker 3 24:25

Right.

Sagi Denenberg 24:26

The other thing is to realize that there is a long trial and error here. When I start medication, especially the SSRIs or the tricyclic antidepressant, I tell owners that you need to commit for at least two years. Now, many owners bark a bit and they say, Why two years? And I said, Look, I'll tell you why I came up with this number, why I made up this number. There is no science behind it as such. There is just experience. It takes the medication at least a month to start working when we talk about SSRIs or tricyclic antidepressant TCAs. And after a month, when it starts working, the cat is not coming to you and saying, Hey, look, I look, I feel better.

Speaker 3 25:07

Right.

Sagi Denenberg 25:08

So I tell an owner, once it starts working, a month down the road, now you have to start looking for changes. So take another month to look for those changes. So that's already two months. And if we're at the end of that period, two months, and the cat is doing better in the areas that we expect it to do, and I'll get back to that point in a minute, then great, I have the right medication and the right dose. But if the cat is not doing well, then I have to make a change. Now I often start with a low dose, so I may have to increase the dose. Sometimes you have to change the medication, sometimes you add a second medication. But each time that you do that, well, it's another two months. So the trial and error is minimum two months, but it could easily be six months, eight months. And then there is all the work that we need to do on the behavioral side of things, behavioral modification, environmental changes, training, depending on what the problem is.

Speaker 3 25:56

Right.

Sagi Denenberg 25:57

Before you know it, you might be a year into it. And then the owner comes back and says, Oh, my cat is doing really well and I want to try without medication. And that's the first time I tell them, wait six months. I want to make sure it's not a one-off. I want to make sure it's consistent. And if you come back six months later and the cat is still doing well, great. Now let's taper the medication slowly and gradually and see what happens. And if your cat regresses, well, your cat still needs it. If your cat does not regress, your cat does not need it. Where would that be for the individual cat? No one knows. Some cats need it for two years, some for five, some for life. Bottom line is that whereas all medication has potential side effects, and the key word there is potential, it's also important to remember that the behavior has potential side effects that are usually more dangerous. Because if it's a cat that attacks the owner, or if it's a point where you say my cat is peeing all over the house and I can't keep this cat anymore, unfortunately, in most cases, the outcome to that is euthanasia. Because those cats are not really re-homable. Not many people will voluntarily take a cat that they know will pee around the house.

Speaker 1 27:05

Yeah.

Sagi Denenberg 27:06

And in most cases, the problem, not always, but in most cases the problem is not the environment or the owner, it's the cat. So those cats are not rehomable. So it's important to remember that behavior has side effects too. It's one of the most common reasons for euthanasia in cats, behavior problems. So if the medication takes it off the table, I don't care if the animal is on it for life, even if it might shorten their lifespan, which typically it doesn't, but even if it might, it's still about life quality. So that's important to remember. When you use anything, there is a risk in that. What is the risk of using medications? But there is also a risk in not using medications.

Kristiina Wilson 27:46

Absolutely.

Sagi Denenberg 27:47

So you need to consider that.

Side Effects Versus Behavior Risks

Sagi Denenberg 27:49

Now, the other part about medication that is important to know is what to expect. Unfortunately, many times you see people putting their animals on medication without knowing actually what the medication is supposed to do. Cat is aggressive, here is fluoroxetine.

Speaker 1 28:04

Yeah.

Sagi Denenberg 28:04

And then the concept is maybe the cat won't be aggressive anymore. And it's not going to change that. So it's important to remember that medications only balance biological behaviors, not learned behaviors, just biological behaviors. So it can help the cat sleep better and longer because many of those cats are sleep deprived.

Speaker 3 28:23

Right.

Sagi Denenberg 28:24

Because they are too irritable, too restless, too anxious. So the medication can balance that and help them sleep more because they're calmer. Not because they are drowsy, because they are calmer. Sometimes the medication can help them eat better. Many times owners see their pets wolfing down the food. There is a concept that I put the food down, the animal should eat it really fast. That's a hardy appetite. Missing the fact that that's binging.

Speaker 3 28:48

Yes.

Sagi Denenberg 28:49

Good appetite is when the cat is nibbling eight to ten meals a day here and there, not immediately eating all. Conversely, there are cats that will not eat if the owner is not around. Missing the fact that this cat has intermittent anorexia. It's not comfortable to eat when you're not around and it's waiting for you to be there, so I'm more calm and now I can eat. Well, medication can balance that. It's about a cat that may react, but to a lower degree. Just as an example, cats that are irritable when the owner pets them, and within 30 seconds of petting, the cat will attack the owner. Well, if the medication works well, it might buy the owner five minutes to pet before the cat attacks you. The cat still doesn't like it. That's a cognitive awareness. I don't like when you do that, but I'm just more tolerant. So medications normalize biological behaviors, they help the animal to relax, they help the animal to calm down faster than before. So there isn't those mood swings, it balances them to a lower level. Now, even with side effects, owners are concerned about side effects, and I understand that. Any medication has potential side effects, but as I said earlier, it's about cost-benefit ratio. But some of the reported side effects, especially with SSRIs, are not true side effects. They're misunderstanding of what is normal. Like I said earlier, many people are used to an animal that eats very fast, missing the fact that it's binging. And then you put the animal on SSRI and you put the food, and the animal goes, the cat goes to the food, eats a little bit, leaves it, goes back later, leaves it. An owner may report that the cat lost its appetite. Whereas that may be a side effect. It's also a beneficial effect because maybe your cat was binging and now your cat is eating normally. Same with sleep. One of the most common concerns is that my animal is a zombie. Well, cats ought to be sleeping about 16 hours a day. And many cats, unfortunately, only get to sleep, say, eight, nine, ten hours a day, because the rest of the day they're too busy, irritable, restless, following the owner, things like that. And if an owner thought that that was normal, and now you put the animal on a medication and the cat starts sleeping 16 hours a day, you might say, oh, my animal is drowsy, lethargic, zombie, any word you want to use, missing the fact that no, what you had before was hyperactive. Now you have good sleep.

Kristiina Wilson 31:09

Or hyper-vigilant, which is like another stress sign. Yeah.

Sagi Denenberg 31:13

Exactly. So it's really important to educate owners. This is what you need to look for. This is what normal looks like. So then you know if the medication is working well. It is not going to change the behavior. You, the owner, will change the behavior.

Speaker 3 31:27

Right.

Sagi Denenberg 31:28

Not the medication. Medication is a tool. It's a tool no different than a harness or a leash or a muzzle for a dog. It's just a tool to help you work with the animal. That's all there is to it.

Oral Dosing And Transdermal Reality

Kristiina Wilson 31:39

Yep, absolutely. I just want to quickly get your thoughts on transdermal applications of some of these behavioral meds because I know owner compliance and administration can often be an issue. So I'm just curious where you land on that issue.

Sagi Denenberg 31:54

I always say that I would rather take my chances with an aggressive rottweiler before I'll take it with a cat that doesn't want its pills. But don't get me wrong, I love rottweilers. Yeah, I didn't think it's just a concept.

Speaker 1 32:06

Yeah.

Sagi Denenberg 32:06

Yeah, it's certainly a challenging point. And we we do struggle with that. Our owners struggle with that. We try and find different ways, whether it's a compounded medication into different flavors. And cats are really partial to fish and seafood, so we usually start with that. And generally, fish have very strong flavors and aromas. So if you can hide a medication, assuming the cat doesn't have any fish allergies, hide it in sardines or on chobby paste. That usually works. Sometimes not. Transdermal is an issue. It's an issue on different levels. There were several older studies done, including one about fluoroxetin transdermal that a colleague of mine, John C. Ribassi, did about 25 years ago. They found that the bioavailability of fluoroxetin transdermal was only about 10% in comparison to the oral one. And there was another one done on the amatryptyline, the old tricyclic antidepressant. And similarly, it was very unreliable. So that's one problem. It depends also on the skin temperature. If it's warmer, it will absorb faster. If it's not, it will take longer. In a multi-cat household, there is always the risk that another cat would lick that. Some cats even don't like that application because you need to find a hairless part, like the uh inner part of the ear. Uh they may scratch it. In some cases, it can cause uh contact. Yeah. So it's not perfect. With that in mind, two recent studies that came in the past two, two and a half years, one of them I reviewed for the journal, and one I read, they looked, sorry, they looked at uh GABA pentin transdermal and trusodon transdermal. And their result was actually better in a sense of bioavailability and efficacy. I would always opt for an oral application if possible, administration if possible, but when not possible, dependent on the problem, I may look at tracedone and gabapentin transdermally. I will have a good discussion with the owner about what to look for, what are the risks of doing that. Again, especially in a multicat household. But if the owner has no other option, I would give it a try.

Speaker 3 34:22

Yeah.

Sagi Denenberg 34:24

I would give it a try because sometimes it's the best way or the only way. What I don't do is I don't force the cat to do that. Many owners will say, Oh, I can open their mouth and I can shove the pill. Say I rather try without medication than doing that because I don't want more conflict between you and your cat.

Kristiina Wilson 34:42

Yeah. We yeah, I think the concept of chasing around an already anxious and stressed cat in order to pill them to combat their stress is antithetical. It's very stupid.

Sagi Denenberg 34:53

I had an honor several years back that claimed that the medication causes cat to be more avoidant and as a side effect, that it made his cat hiding. And then we found out how the owner was administering the medication, and no wonder the cat was hiding.

Kristiina Wilson 35:07

Yeah, yeah.

Sagi Denenberg 35:08

So, no, we want to give medication when necessary, but we don't want to make it worse by giving the medication. Not because of the medication, but because the way you give it.

Kristiina Wilson 35:16

Exactly. Yes, 100%. All right. Well, thank you so much. I really appreciated this conversation. I still have one billion questions for you, so maybe we can find another time for you to come back on. And I think listeners would love to hear more of a discussion. So I really, really appreciate your time. This was super interesting, and thank you for all the work that you do for animals.

Sagi Denenberg 35:37

You're welcome. It was nice chatting, and we'll talk again in the future.

Kristiina Wilson 35:40

Okay, have a wonderful rest of your day.

Sagi Denenberg 35:42

Bye-bye for now.

Closing Thanks And Resources

Kristiina Wilson 35:44

Thanks so much for listening to the show. If you're looking for one-on-one support with behavior issues like litter box problems, aggression, anxiety, or multicat dynamics, you can find me through my behavior consulting business, Catitude Adjustment, at catitude adjustment.com. If you like the episode, please consider leaving a rating or review. It really helps us grow. For more episodes, show notes, and resources, head to hissandtel podcast.com. Huge thanks to Cat Beats for the music, and I'll see you next time.