fluoxetine not as affective anymore, cat is very fearful. help!!!

[toulousesmomma]

hey yall! firstly, i have 10+ years experience working with/owning cats. I'm more well versed on animal nutrition, health and behavior than the average person but I'm still at a loss with my cat. She is 5 years old, completely blind, and spayed. She had her eyes removed at 6 months old and is extremely well adapted. After we moved she began to display a lot of anxiety and fearful behavior with my male cat who she has always lived with and got along with well. They were best friends and I used to joke that my boy cat was her emotional support animal because he was always with her since I was fostering her and all throughout her healing process after her surgery. Her anxiety got so bad that she would actually lash out at him in defense, even if he wasn't doing anything to her. He would just walk by her and she would swat at him, hissing and growling. We tired EVERYTHING. Private behaviorist, supplements, feliway, separating and reintroducing, hiding boxes, calming music, vertical space, you name it. It was so bad at one point that my partner and I couldn't move if she was in bed with us because she would get so scared and frantic, we thought maybe she thought us moving was my boy cat and she would hiss and growl and jump off the bed and try to hide, even when he was not in the room with us! But when we would pick her up or pet her she would be fine and act normal again. We ended up having to move a second time. (first move was 2020 second was 2021) It got way worse when we moved the second time and we finally put her on fluoxetine which was a night and day change. I wish we had started it sooner honestly. She went back to almost completely normal. She never went back to being best friends with my boy cat but she could be in the same room with him and sleep in our bed with him without issues. It's been mostly fine for the last three years with the occasional hissing and growling if my boy cat tried to play with her.

Now however, it seems like the fluoxetine is wearing off. It's not as affective and shes starting to hiss and growl at him way more frequently, on a daily basis. She's hissing at me and my partner now too again. Whenever she gets upset and is hissing at my boy cat, one of us gets up to get her and calm her down but she hears our foot steps and begins to run away in a panic and bumps into shit which makes her even more frantic. We try to be as calm as possible and say her name really softly and not get angry with her but idk it's like she thinks WERE my boy cat coming after her? Once I pick her up she is a baby again though it's so strange. And she will still lick my boy cat randomly? She will go over to him and begin to groom him but then after a few seconds she stops and hisses suddenly at him. I've observed them do this time and time again. No ones body language changes, my boy cat wont be moving, sometimes he's sleeping when shes grooming him and she just out of nowhere starts hissing. And I am not usually one to say an animal "did something out of nowhere" because most of the time, almost always, animals give us a lot of signs, but Luna is like a switch flipping on and off suddenly...

Aside from this she seems like a really happy normal cat. She plays, eats, cuddles, purrs, grooms herself, and follows me around the house like a shadow. We also have a dog and she is not scared of the dog the same way at ALL.
I consulted my vet and he said we could take her off fluoxetine and switch her to amitriptyline, but I'm worried weaning her off fluoxetine is going to be really really bad. And worried that amitriptyline wont be affective. I have another vet who says we could do amitriptyline and fluoxetine at the same time? But I can't find anything about this online. I don't want to do something that is going to make her worse or accidentally cause an overdose or something.

Details: shes on 5mg of fluoxetine, weights about 8-9 pounds. I am home with the animals almost always. i leave the house maybe 1-2 a week, sometimes more but majority of the time im home with them. whenever no one is home, luna goes in her own room. we have a spare bedroom and she has her own litter box, she eats in there separate from my boy cat who eats on a separate floor, a cat tower, a bed, and plenty of toys. she is never alone unsupervised with my boy cat. We think maybe she might have some sort of head trauma that MIGHT be contributing to this? The only reason we think this is because she bumps into things due to her blindness? When she had the surgery to remove her eyes she had a lot of weird behaviors like head tilting, walking in circles and being stuck in loops, wanting her eye sockets pushed.... things that are usually indicative of a stroke. We have not gotten a CAT scan or MRI for her though because my vet said even if we did find out she had a stroke, there isn't really anything they can do about it? She had her eyes removed due to having corneal ulcers that ruptured and damaged her eyes to the point where she couldnt see and they were very painful for her.

any help or advice or other folks experiences would be welcome! thanks everyone. I am willing to do anything to help her. right now we have to just put her in her bedroom when she gets like this because she is so frantic and upset. I do not like having to put her away though because she is such a people cat and loves being with us. but i also dont want to put my boy cat away either because he is almost 15 and is having weird urinary issues.

Also Luna has been to a vet recently, she's had blood work done within the last sicks months and everything is normal. She has no other issues that we know of.

forgot to add, i have posted a few times about luna's situation prior to her being on fluoxetine if reading those posts would be helpful/give more insight.

also toulouse my boy cat has had urinary issues on and off since he was four years old and had issues multiple times in the two years he and luna lived together well. the fear and anxiety did not happen till we moved and i think that is the biggest factor her. i know animals pretty well and i really do not think her fear/anxiety is due to his health problems. another reason i think this is because i had a third cat and she was anxious and fearful of this one too and this one did not have any health issues. i rehomed her to my old partner since we had gotten her together

 

[Furballsmom]

Hi
Have you checked the interior of the new living space with a blacklight for previous animal pee and puke spots that weren't fully cleaned?

In that same train of thought, what's going on outside that she can hear and smell?

 

[FeebysOwner]

Hi. I don't recall reading anything about fluoxetine losing effectiveness over time, but I believe that dosage adjustments have been needed in some cats with long term use. it may be something to discuss with your vet and see if there are alternatives to try.

If there are 'new' things going on outside your home that she can sense/smell, as mentioned above. she could be re-directing her anxiety over them onto Toulouse. Not as unusual as some might think.

The only other thing that came to mind is Toulouse's health. I know you don't feel as if Luna has necessarily reacted to him because of his urinary tract issues. However, given his age, and the likelihood of additional medical issues cropping up, she may actually be sensing a new health condition in him.

 

[Alldara]

My understanding of visual impairment comes from humans. But as I understand with full blindness, keeping things the same for navigation is important.

Now, you had to move, I'm not placing any blame. But my best guess is that learning to navigate these new places is making her fearful. Fearful cats lash out. In your post, when you say she didn't even like movement on the bed really points to that for me.

When my wife and I were nannying a baby with blindness, a big important factor was using play to promote safe exploration, especially of the environment.

I think she needs her confidence built up. You can do this through play, but another poster gave an idea the other day that might also help because it's scent based: taking an old blanket and having her get her scent on it, then you cut it in squares and slow expand her safe base through these scent markers.

You can also give her other enrichment through scent. If you get some soft crinkle balls and some fresh (cat safe) herbs from the store, you can have the balls scented with the herbs and put them in a homemade cat puzzle.

 

[silent meowlook]

I truly think a consultation with a board certified veterinary behaviorist will help. You need a veterinarian that went on and did the additional years of behavior study, internships, etc. and passed a two day long test. They also have to compete a certain amount of hours of CE each year. That would be the best place to start.

When cats get upset they often have displaced aggression. Basically taking it out on whatever is nearest to them.

She also may have another medical issue coming up that you haven’t discovered yet.

Still, I would go the veterinary behaviorist route.

 

[toulousesmomma]

I truly think a consultation with a board certified veterinary behaviorist will help. You need a veterinarian that went on and did the additional years of behavior study, internships, etc. and passed a two day long test. They also have to compete a certain amount of hours of CE each year. That would be the best place to start.

When cats get upset they often have displaced aggression. Basically taking it out on whatever is nearest to them.

She also may have another medical issue coming up that you haven’t discovered yet.

Still, I would go the veterinary behaviorist route.

We have already talked to our veterinarian behaviorist. The weird thing is she is ONLY fearful of my cat Toulouse. Nothing else at all is triggering her. I have a dog in the home and the dog gets near her and wags her tail and smacks her in the face sometime and it doesn't phase Luna at all. We have been living in the same home for about 3 years now and we haven't changed the layout or furniture in 2 years. She has it mapped out well and has no issues getting around the house. Nothing is going on outside either and I have done all the stuff that everyone is suggesting. She gets blood work done every six months and gets regular check ups. If there is a weird medical issue she's developing, I have no idea how we would go about figuring out what it is if her blood work looks good. She is acting otherwise completely normal and a lot of the time with Toulouse she is unbothered. As I'm typing right now they are both sitting in the living room with me and Luna is not hissing, growling or acting fearful of him.

Sometimes I wonder if she has some sort of brain damage that makes her randomly triggered. She will start grooming him and be purring but then a second later she is hissing and growling at him. It really is very random and doesn't make much sense.

 

[toulousesmomma]

My understanding of visual impairment comes from humans. But as I understand with full blindness, keeping things the same for navigation is important.

Now, you had to move, I'm not placing any blame. But my best guess is that learning to navigate these new places is making her fearful. Fearful cats lash out. In your post, when you say she didn't even like movement on the bed really points to that for me.

When my wife and I were nannying a baby with blindness, a big important factor was using play to promote safe exploration, especially of the environment.

I think she needs her confidence built up. You can do this through play, but another poster gave an idea the other day that might also help because it's scent based: taking an old blanket and having her get her scent on it, then you cut it in squares and slow expand her safe base through these scent markers.

You can also give her other enrichment through scent. If you get some soft crinkle balls and some fresh (cat safe) herbs from the store, you can have the balls scented with the herbs and put them in a homemade cat puzzle.

I do think the initial moves are probably what triggered it, even though it seemingly happened over night. When I moved her she seemed perfectly confident and happy and played, cuddled, and acted like herself. Then one day I came home from the store and she was cowering and being fearful of Toulouse. It's possible of course that he maybe did something to her, but I wasn't home so I have no way of knowing. (they are separated now whenever I'm not home for this reason)

The current house were in we have been living in for about 3 years and we haven't changed the layout or furniture recently at all. She seems to have a very good mindmap of the house. For example, our kitchen is on the first floor and she eats in the spare bedroom upstairs so she is away from Toulouse and the dog. When we feed her she comes into the kitchen and then runs excitedly to the stairs and goes up them so fast sometimes that she's hopping. She turns the corner and goes into her room and to her food mat to eat. Very occasionally she will bump her head on the stair railing.

We also have lots of toys for her in her room as well as downstairs and in the other bedroom and I have a few food puzzles for her that I use for enrichment.

The thing that just doesn't make sense to me is why she is sometimes okay with Toulouse and then sometimes not. I will have them both on my lap sleeping peacefully some days and then other days if he gets near her she hisses and growls and runs away in fear. I definitely don't think boosting her confidence would hurt, but at this point I'm not sure if it is truly a confidence thing or if it's something else?

 

[toulousesmomma]

Hi
Have you checked the interior of the new living space with a blacklight for previous animal pee and puke spots that weren't fully cleaned?

In that same train of thought, what's going on outside that she can hear and smell?

Nothing new is going on outside. There are birds chirping. I don't know what she can smell aside from plants. We don't live near any restaurants or anything like that that she could smell. The neighborhood is mostly pretty quiet.

I haven't black lighted the interior but we have been living here for three years at this point and she was fine before. It really just seems like the fluoxetine is loosing effectiveness because I cannot pinpoint any new major changes that would be causing her distress.

 

[toulousesmomma]

Hi. I don't recall reading anything about fluoxetine losing effectiveness over time, but I believe that dosage adjustments have been needed in some cats with long term use. it may be something to discuss with your vet and see if there are alternatives to try.

If there are 'new' things going on outside your home that she can sense/smell, as mentioned above. she could be re-directing her anxiety over them onto Toulouse. Not as unusual as some might think.

The only other thing that came to mind is Toulouse's health. I know you don't feel as if Luna has necessarily reacted to him because of his urinary tract issues. However, given his age, and the likelihood of additional medical issues cropping up, she may actually be sensing a new health condition in him.

I did talk to her vet about this and he didn't mention adjusting the dosage. I think for her weight she is on the highest safe dosage. I've read it's very easy for cats to overdose on fluoxetine so I'm hesitant to give her more. My vet said if the fluoxetine isn't working properly we could try stopping it and giving her amitriptyline instead. I haven't done this yet just because I'm worried her weaning off fluoxetine is going to make her as bad as she was before the fluoxetine. I think I mentioned it in my post but when this was at it's worse, just walking around near her would freak her out and cause her to cower in fear and hiss. I was still able to pick her up and handle her and she would calm down when she realized the noise was me and not Toulouse. She isn't that bad again yet but if I take her off fluoxetine completely it might get that bad again. Plus amitrip takes time to work from my understanding, so were talking maybe ~3 weeks of her being so terrified that we can't even have her in the room with us.

Another vet I talked to mentioned using amitrip and fluox together, but I cannot find ANYTHING online about that and I am scared of her overdosing or getting sick or having some really adverse side effects.

I do still think it's unlikely that she is reacting this way due to Toulouse's health, however, let's say that was the reason. What do I do to help with that? (Toulouse gets his urine and bloodwork checked on a monthly basis now because of his unique issues going on. His chemistry all looks good and everything is mostly normal aside from when he gets a UTI, then his WBC go down. urine work looks great when he doesn't have an infection, so I'm not sure what new health issues she could be sensing. I know he is older but his kidney values look normal and good for his age.)

 

[FeebysOwner]

I do still think it's unlikely that she is reacting this way due to Toulouse's health, however, let's say that was the reason. What do I do to help with that?

If her over reaction is primarily when she is near Toulouse, then it would stand to reason that there is a connection to him somehow. If he isn't antagonizing her, which I didn't get the impression that he does anything of the sort, then the next logical step is consider something else about him, such has his scent, triggers her. Bloodwork and urine aren't the only indicators of a cat's overall health. Is he on any steady medications, which can cause scent changes? Does he get routine dental checks? Anything going on in the mouth can affect smell too. Does he go outside and bring in a different smell with him that triggers her? Does he eat different food from her and that affects his smell? Does he get baths or has wipes used
on him? These are just some of the examples that might be a cause. Not knowing everything about your home, I can only guess - there may be more examples you could come up with.

Another vet I talked to mentioned using amitrip and fluox together, but I cannot find ANYTHING online about that and I am scared of her overdosing or getting sick or having some really adverse side effects.

Some other med may need to be tried, if there is no other source found. I think fluoxetine and amitrip are two different classes of drugs, so as far as I know they can be used together. If not those two specifically, then similar ones. But, there are newer drugs on the market that combine both these types of drugs, and therefore given the dosage change, tend to have less side effects. Maybe this article will give you some things to discuss with the vets?
Combination SSRIs/TCAs: Your guide to treating behavioral disorders (dvm360.com)

 

[silent meowlook]

Cats are weird. At least to people they are. She probably had a bad experience with the other cat 3 years ago and just hung on to that.

I have 2 cats. Omypaw is 3 yrs and 11 lbs. cheetah is 6 lbs. Cheetah was here first. I did gradual introductions. Every now and then Cheetah will start to groom Omypaw. Then she smacks him in the face and runs. He chases.

The cat before Omypaw was Rusty. Cheetah and Rusty loved each other and slept together. Sometimes Cheetah would groom Rusty, smack him on the head and run. He would just look stunned.

Since most cat to cat communication is non verbal and is physical, I am sure that your cat struggles with this because she is blind. Also cats will “read” other cats through pupil size etc. her not having eyes make this hard on your other cat.

You can try to do some scent swapping and also keeping awareness of any sort of scents in the home, because I am sure your blind cat’s scent is enhanced. She probably can smell if your other cat is having a urinary issue, and in my experience, cats aren’t always big on compassion.

 

[Furballsmom]

we have been living here for three years at this point and she was fine before

I apologize, I missed your mention of the timeline.

Even though you've mentioned you don't think this is a reason, feebysowner may be on to something regarding her reaction to your other cat's health issues, since every cat is different. (You're working to get him to drink as much as possible with fountains, filtered water etc?)

Then one day I came home from the store and she was cowering and being fearful of Toulouse.

However, this sounds to me like a version of redirected aggression from something that occurred that day, most likely outside your house that was animal-related. If you don't have cameras outside, you don't know if there are strays, ferals or other animals in your neighborhood and crossing your yard. She can most definitely hear and probably can smell those animals, especially if there was a cat fight outside. Forward to today/now, if there are still animals crossing your yard it could explain why her behavior is inconsistent. Also, if you can determine whether there are in fact animals there, you can take action (for example motion activated sprinklers) and stop them from entering your yard/coming close to the house, and thereby helping your blind cat.

she hears our foot steps and begins to run away in a panic and bumps into shit which makes her even more frantic. We try to be as calm as possible and say her name really softly and not get angry with her but idk it's like she thinks WERE my boy cat coming after her? Once I pick her up she is a baby again

Is she loosing her hearing? In other words, your posts are reading like she is feeling the vibrations of your footsteps, and the movements of the bed and bedding, but since she regularly doesn't become calm until you touch her even though you're saying her name and I assume talking to her, it's making me really wonder about that aspect.

When she had the surgery to remove her eyes she had a lot of weird behaviors like head tilting, walking in circles and being stuck in loops, wanting her eye sockets pushed....

I'm confused about this part though. Since she had these behaviors then, why are you thinking she has had head trauma? If she's still experiencing some sort of neurological issues, maybe there's a different approach that can be used. Slightly off the subject, but does she still like having her eye sockets pushed?

 

[toulousesmomma]

If her over reaction is primarily when she is near Toulouse, then it would stand to reason that there is a connection to him somehow. If he isn't antagonizing her, which I didn't get the impression that he does anything of the sort, then the next logical step is consider something else about him, such has his scent, triggers her. Bloodwork and urine aren't the only indicators of a cat's overall health. Is he on any steady medications, which can cause scent changes? Does he get routine dental checks? Anything going on in the mouth can affect smell too. Does he go outside and bring in a different smell with him that triggers her? Does he eat different food from her and that affects his smell? Does he get baths or has wipes used
on him? These are just some of the examples that might be a cause. Not knowing everything about your home, I can only guess - there may be more examples you could come up with.


Some other med may need to be tried, if there is no other source found. I think fluoxetine and amitrip are two different classes of drugs, so as far as I know they can be used together. If not those two specifically, then similar ones. But, there are newer drugs on the market that combine both these types of drugs, and therefore given the dosage change, tend to have less side effects. Maybe this article will give you some things to discuss with the vets?
Combination SSRIs/TCAs: Your guide to treating behavioral disorders (dvm360.com)

he gets routine dentals and is on gabapentin and amitriptyline right now for bladder issues. he is also on different food than her now, however back in 2020 when all of these issues first started, Toulouse was not on meds and he was eating the same food as her. There does seem to be a connection with Toulouse but I can’t figure out what it is. This morning for example, she was in my bed and Toulouse was too. Toulouse was sleeping and she walked over to him, smelled his head and then started to groom him. She continued to groom him for a few minutes peacefully. Then Toulouse lifted his head up and she hissed and growled at him.

I’ll check out the article. I definitely think she needs a new med or new combination of meds because this is negatively affecting her quality of life. Toulouse is 15 and I don’t know how much longer i’ll be blessed to have him, but I don’t want luna suffering during that time