Page 1809 - Cote clinical veterinary advisor dogs and cats 4th

906 Separation Anxiety

• The pace of the behavior modification must PO q 12-24h (cats); tricyclic antidepres- PROGNOSIS & OUTCOME
sant (TCA) is drug of choice in mild cases.
proceed at an appropriate rate that allows ○ Clomipramine (Clomicalm, Novartis, • Prognosis is improved by early diagnosis,
VetBooks.ir the owner is trying to progress too quickly minimum of 8 weeks) 2-3 mg/kg PO q • With chronic separation anxiety, treatment
improvement. If the patient is distressed,
aggressive treatment, and dedicated clients.
12h (dogs); 0.5 mg/kg PO q 24h (cats);
or is not recognizing/rewarding the correct
behaviors. Video the dog/client team.
• If panic, noise phobia, or storm phobia TCA licensed for use in separation may be lifelong, especially if there are
comorbid anxiety-related conditions.
anxiety and most successful when the
coexist (p. 787), consider behaviors have a ritualistic or elimination
○ Alprazolam (dogs) 0.01-0.1 mg/kg (likely component PEARLS & CONSIDERATIONS
most effective range: 0.02-0.04 mg/kg) ○ Selective serotonin reuptake inhibitors
PO q 4-6h prn; (cats) 0.0125-0.025 mg/ (SSRIs) (minimum of 8 weeks): fluoxetine Comments
kg PO q 12-24h prn. NOTE: some (Prozac/Reconcile) 1 mg/kg PO q 24h • If a veterinarian is not comfortable treat-
published sources recommend a 10-fold (dogs); 0.5 mg/kg PO q 24h (cats) or ing separation anxiety, the patient should
higher dose, which is an error. sertraline (Zoloft) 1 mg/kg PO q 24h be referred to a specialist immediately
○ Diazepam (dogs) 0.5-2 mg/kg PO q 4-6h (dogs); 0.5 mg/kg PO q 24h (cats) (www.dacvb.org for a listing in the United
prn; (cats) 0.2-0.4 mg/kg PO q 12-24h ○ Polypharmacy (adding benzodiazepines, States). Screen for and treat any comorbid
prn, which is more sedative. Give one-half alpha-agonists, gabapentinoids) may help anxieties, especially those associated with
to a full dose 2 hours before the expected by combining prn and daily treatment. noise.
provocative event and repeat 30 minutes ○ Long-term treatment is the rule. When • Dog trainers may have mistaken beliefs
beforehand. Can give one-half to a full dose using medication with behavior modifica- regarding separation anxiety that could do
the night before and/or on awakening in tion, medications are typically continued real harm.
the morning and then give the same dose at least 4-6 months.
30 minutes before departure. Prevention
○ Clonidine 0.01-0.05 mg/kg PO q 12h Nutrition/Diet • Dogs obtained by rescue or from puppy mills
(total daily amount typically 0.9 mg for Polyunsaturated fatty acids may help protect should be screened aggressively for separation
most dogs) may help very reactive dogs. neurons from oxidative stress. anxiety to facilitate early intervention.
○ Gabapentin 10-20 mg/kg (starting dose) • Veterinarians should inquire about behavioral
PO q 8-12h can help many dogs in Behavior/Exercise problems as a routine part of every appoint-
combination with other medications. Regular aerobic exercise may help but is not a ment. Left undiagnosed and untreated,
○ Dexmedetomidine (Sileo, Zoetis) can be substitute for treatment. separation anxiety worsens.
used in dogs off-label for arousal associated • Breeders should consider medical and
2
with departure (125 mcg/m ) (p. 609) Drug Interactions behavioral issue when selecting breeding
given at least 30 minutes before leaving. • Benzodiazepines, TCAs, and SSRIs can be stock. Propensity for anxiety disorders is
combined at lower-than-normal dosages if likely heritable.
Chronic Treatment needed, but the potential for sedation and
• Dogs should be taught to relax while making interaction must be evaluated. Technician Tips
eye contact with people as a new default • TCAs and SSRIs should not be given with Technicians should review all signs of anxiety
behavior when the dogs encounter a situation monoamine oxidase inhibitors (MAOIs) with clients, review patient video, and
about which they are anxious/unsure. Clients that are found in many ectoparasite control note improvement or worsening of signs.
should learn to monitor facial cues, body products and in some cognitive dysfunction Resources include the Pet Professional Guild
postures, pupil size and shape, and respiratory medications. (www.petprofessionalguild.com) and the
behavior associated with relaxation. Periodic Society of Veterinary Behavioral Technicians
videotaping, reviewed by the clients with Possible Complications (www.SVBT.org).
their veterinarian, is priceless. • Abrupt cessation of medications with short
• Avoid exposing dogs to circumstances likely half-lives is not recommended for TCAs and Client Education
to distress them (e.g., boarding dogs in a SSRIs; wean over 10-14 days. • Pets with separation anxiety are distressed;
kennel). • TCAs should be used cautiously or not at they are not vindictive, jealous, spoiled, or
• Desensitization to the triggers can be accom- all in patients with heart disease. disobedient.
plished if two criteria can be met: triggers • Cats and dogs receiving serotonergic • Under no circumstances should patients be
can be identified and are limited, and they medications rarely manifest serotonin-like punished or physically disciplined because
can be reproduced faithfully in a systematic syndromes with hyperactivity, unpredict- it will increase anxiety.
and incremental fashion. Many dogs learn ability, and ultimately, seizures. • Treatment should be long term and often
to react earlier only if gradual departure is lifelong.
desensitization programs are inappropriately Recommended Monitoring • Relapses may occur with treatment discon-
conducted. Trainers may not appreciate this. • Frequent and thorough communication tinuation or added stressors. If stressors are
• Crates may represent entrapment to some between clinician and client is essential to anticipated, premedication may be helpful.
patients and can make the patients worse. allow treatment plan adjustment according • Clients must understand and screen for
Use crates as part of treatment only if the to the patient’s response. comorbid anxieties so that they can be
pet enjoys the crate. • Physical exam and routine laboratory testing addressed.
• After the patient has improved, it is impor- (CBC, chemistry profile, urinalysis) are
tant that the owners consistently continue the repeated q 6 to 12 months for pets taking SUGGESTED READING
behavior modification. A decreased response medications. King JN, et al: Results of a follow-up investigation to
to an inciting trigger is the desired goal. • To reduce risk of owner abuse of benzodi- a clinical trial testing the efficacy of clomipramine
• Humane treatment of separation anxiety azepines, do not allow automatic refills, and in the treatment of separation anxiety in dogs. Appl
likely requires long-term treatment with schedule frequent follow-up appointments. Anim Behav Sci 89:233-242, 2004.
antianxiety medications. • Clients can monitor heart rate at home to AUTHOR & EDITOR: Karen L. Overall, VMD, MA, PhD,
○ Amitriptyline (minimum of 30 days) detect tachycardia associated with anxiety DACVB
1-2 mg/kg PO q 12h (dogs); 0.5-1 mg/kg or drug therapy.

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