Dogs, our sunny, selfless shadows, crave little more than a daily walk, a treat or two, and their human’s happiness. But increasingly, their own happiness is the topic of concern in veterinarian offices, dog parks, and internet forums.
Prozac prescriptions for dogs are on the rise, veterinarians across the country acknowledge, along with a myriad of cheaper generic mood stabilizers sold for humans but applied to pets’ separation anxiety, socialization fears, biting habits, or other problematic behavior.
That increase, experts told STAT, says more about the human mental health crisis in America — and the ready availability of inexpensive generic medicines. Americans have reported more depression and anxiety in recent years, and everyone is talking more about it. But while behavioral specialists, therapists, and counseling services have struggled to keep up with the onslaught, relatively inexpensive antidepressants haven’t.
“The human world has become more attuned to mental health. Since Covid, we’re talking about it,” said Melissa Bain, a veterinarian focused on behavioral medicine at the University of California, Davis. “When we start to recognize things in humans, we recognize it in our dogs too.”
We need to talk about Buddy
The apparent mental health crisis in pets comes in the midst of a very clear human one. Americans’ depression and anxiety rates hit record highs during the pandemic and keep moving upwards. Prescriptions for mood stabilizers like Prozac and Zoloft surged during Covid-19 — on top of steady increases since the ’90s — sometimes triggering shortages of the medications.
Meanwhile, licensed providers are struggling to meet the demand for psychotherapy and other behavioral health needs, while federal regulators are pressing for more affordable access to these services.
“Mental health is a sock that [we] stretched out, not a rubber band,” said Ken Duckworth, chief medical officer of the National Alliance on Mental Illness. “People have not snapped back to a pre-Covid baseline.”
At the same time, there is a glaring bottleneck in services. The demand for psychological support and psychiatry far outstrips the number of health care workers in the field. Booking appointments can take weeks to months for many Americans, and perceived improvements even longer. Organizations like the American Psychiatric Association are touting the benefits of therapy animals and nature therapy, while proclaiming the mental health benefits of pet ownership.
Pet psychiatry mirrors human trends in several ways. Veterinarians across the country say they are writing more anti-anxiety prescriptions, though it’s difficult to quantify the increase in prescribing trends exactly. Veterinarians in five different states told STAT they were seeing steadily increased pet prescriptions for popular mood stabilizers like Prozac, though it is virtually impossible to get a full picture of the trend nationally since prescribing data for pets is scattered (and usually under their owners’ names).
As in the human world, oftentimes a prescription — particularly for a cheap, generic anxiety pill — is easier and more affordable than the hundreds to thousands of dollars that training classes or boutique behaviorist practices that vets also recommend can cost.
Generic versions of these medications — especially the lowest-dose versions that many of our smaller, furrier friends are prescribed — typically retail between $10 and $15 a month. The pet-approved version, Reconcile, is slightly more expensive. Training courses and specialized behaviorists, meanwhile, can run into thousands of dollars. For many people, it’s an easy choice.
Our converging prescription worlds
Dogs are taking, essentially, the exact same drugs for depression and anxiety that humans are. One of the most commonly used antidepressants — in both the human and animal realms — is Prozac and its generic version, fluoxetine. Reddit boards for reactive pets and veterinary questions host hundreds of posts about pets’ successes or struggles with that, Zoloft, Paxil, Celexa, and their generic versions.
Analysts expect the global market for these medicines to continue growing from roughly $11.6 billion in 2019 to more than $18 billion by 2027.
They’re easy to access because they’ve been around for years — in fact, little in the world of psychiatric medicine has changed in the last two decades. Once Prozac, Zoloft, and other selective serotonin reuptake inhibitors went generic, the efficacy and low prices meant few doctors were willing to put their patients on name brands — and few big drugmakers were enticed into developing next-generation options.
When new drugs do hit the market, they’re often narrowly approved (like the Sage Therapeutics medicine for postpartum depression) and pricier. The same is true in the doggy drug world, where there is just Reconcile, the one FDA-approved fluoxetine option — cleared specifically for separation anxiety.
The demand among pets isn’t cause for concern about shortages, experts were quick to say. Currently, no antidepressant is on the national drug shortage list. Zoloft and its generic version sertraline was, back in 2020, when a combination of surging demand and supply chain interruptions amid pandemic shutdowns triggered problems securing enough of the active ingredients, which are usually manufactured in India or China. Pfizer, Zoloft’s manufacturer, was able to ramp up production within months.
“We definitely have had shortages of basically all of the big SSRIs — whether that’s fluoxetine, paroxetine [Paxil], sertraline, over time,” said Erin Fox, a University of Utah pharmacist who tracks shortage problems. “It hasn’t been too many, but when they happen, they definitely seem to last for a while.”
Those can lead to patients — human or canine — moving to different doses or even other medications while manufacturing smoothes out. In one case, with a lesser-used antidepressant called nefazodone, it took nearly two years for its single manufacturer to reverse shortages.
“Part of that is just because of the generic landscape and so many different products being gone,” said Fox, referring to a lessened appetite to make cheap generic drugs. But she also warned that we could see more shortages for all types of medications in the coming years as the FDA ramps up pandemic-delayed or suspended factory inspections that could flag problems and subsequently stall production.
“It goes hand in hand with an increase in demand for psychiatric services. But some [media] outlets present [increased prescriptions] as a secondary problem, which don’t quite see that,” said Petros Levounis, president of the American Psychiatric Association, referring to a narrative about the broader mental health crisis. “I don’t think you would ever say something like ‘we see an increase in people’s hypertension, and we see an increase in the hypertensive medications.’ That just goes hand in hand.”
Is this trend about us?
Veterinarians who spoke to STAT chalk the rise in pet psychiatry up to a number of factors: We care more, as a culture, about animal welfare these days. There also has been a persistent pilgrimage of rural rescue animals plucked from southern states and shipped to cities with more capacity and resources for adoption — but also far more people, noises, and environmental stressors. Pandemic shutdowns then exacerbated the trend, with record adoption rates sometimes clearing out whole shelters.
“It’s not surprising that they are struggling in that urban environment, because they weren’t born into it,” said Christine Calder of the American College of Veterinary Behaviorists and owner of Calder Veterinary Behavior Services outside of Portland, Maine. “There are more and more that are on medications; it is also becoming more acceptable.”
But increasingly, human psychologists are studying how companion animals impact our health — and how we impact theirs.
The field has grown exponentially over the past two decades, said Lori Kogan, a Colorado State University psychologist who chairs the human-animal interaction department of the American Psychological Association.
“There’s so many similarities in people’s emotions towards their children and emotions towards their pets,” said Kogan. “We might be, for example, overly anxious about their well-being, just as a lot of people are about their children.”
Some have attempted to study how pet ownership has changed since the pandemic and whether man and best friend helped each other through shutdown solitude and stressors from illness to job loss and anxiety. While pets are broadly considered beneficial to peoples’ mental health, the reverse — how our health impacts theirs — has been sparsely researched until recently.
The benefits for humans seem clear: 84% of pet owners say their smaller housemates have a mostly positive impact on their mental health, according to the American Psychiatric Association’s March 2024 mental health poll, done in partnership with the American Veterinary Medical Association.
In the United Kingdom, psychologists asked roughly 5,000 pet owners how they viewed their own mental health and the welfare of their cats and dogs following strict early shutdowns. The results suggested that when owners themselves felt mentally down, they saw improvements in their pets’ state of being — or at least thought they did.
“It might be that those in greatest need for social support, as evidenced by poorer mental health scores since lockdown, are more empathic towards their animals’ needs,” the British researchers wrote.
Of course, they said, there are limits to this trend: Most of the survey respondents were women and many of them worked outside the home before shutdowns. The survey suggests not that every pet owner became more attuned to their companions’ wellbeing, but that certain populations — likely higher-income people with office jobs that could transfer to stay-at-home work — certainly did.
The human-animal behavioral health bond is a relatively limited field of research compared to human mental health research, but Kogan says it is growing rapidly — and evolving.
“There’s more and more focus on how do we make this mutually beneficial?” she said. “When animal-assisted therapy started, it was very focused on what can animals do for people. And now it’s much more: What can we do for each other?”