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==Psychoactive Drug Therapy==
 
==Psychoactive Drug Therapy==
Cats that are inhibited, fearful and therefore unable to utilise improved resources because of their apprehension, may benefit from psychoactive drug therapy. '''Selegiline''' is not licensed for use in the cat, but it can be used for the treatment of specific fears, a condition for which it is licensed in the dog (in the UK). This drug increases confidence and exploratory behaviour, but takes 4-6 weeks to show efficacy. It should be continued until the cat is fully utilising resources and has not eliminated in the house for 8 weeks.
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Cats that are anxious, inhibited, or fearful may be unable to utilise an enriched or altered environment, or adapt to change. They may benefit from treatment with psychoactive medication.
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Where signs of chronic anxiety are apparent, despite the use of F3 diffusers, then an SRI or SSRI type drug, such as Clomipramine or Fluoxetine, may be appropriate.
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In the dog, '''selegiline''' is licensed for the treatment of behavioural problems with an underlying emotional cause (UK and EU license). It is not licensed for use in the cat, but could be used in accordance with CASCADE. This drug increases exploratory behaviour and decreases apprehension. It can take up to 8 weeks to reach efficacy, but typically some improvement is seen after 4-6 weeks in cats.
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Trial treatments for [[Cystitis|Feline Idiopathic Cystitis]] have included polysulphated glycosaminoglycans and Amitriptyline. Response to glycosaminoglycans was variable, with some individuals responding extremely well and others less so. Treatment with Amitriptyline has produced good results, with the affects being attributed to the nor-adrenergic effects of the drug. Amitriptyline is 5:1 selective in favour of nor-adrenaline over serotonin reuptake inhibition, whereas Clomipramine is 5:1 selective in favour of serotonin reuptake. However, both drugs do have significant effects on nor-adrenaline reuptake and Clomipramine may be a suitable alternative if there are concerns over adverse effects with Amitriptyline.
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Selegiline has minimal anxiolytic effects, so for cats with generalised anxiety or signs of panic a serotonergic drug such as fluoxetie or clomipramine may be preferable. Clomipramine is licensed for the treatment of separate anxiety in the dog, but not licensed for use in cats.  
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Neither selegiline nor serotonergic drugs have a specific indication for inappropriate elimination; they are used to alleviate underlying emotional problems that contribute to the problem. Long term drugs of this kind should be continued until the cat is fully utilising resources and has not eliminated in the house for 6-8 weeks.
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In all cases, psychoactive drug therapy should only be considered after reaching a specific diagnosis and taking into account the risks of disinhibition of aggression. Obstructive urinary tract disease should be ruled out before initiating therapy with SRI or SSRI drugs, which have a risk of increasing outflow obstructions through their effects on acetylcholine transmission.
      
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