Guidance on separation anxiety medication

Christopher Pachel, DVM, DACVB, CABC, on stage during this keynote presentation at the Fetch dvm360 conference in Nashville, Tennessee.

Could prescribing medication be beneficial for your patient experiencing separation anxiety? Christopher Pachel, DVM, DACVB, CABC, owner of Animal Behavior Clinic and co-owner of Instinct Dog Behavior and Training both located in Portland, Oregon, shared his expert opinion on this common behavioral situation during his keynote address at the Fetch dvm360 Conference in Nashville, Tennessee, sponsored by Zomedica.¹ “Separation anxiety is a really common problem. And when we talk about prescribing for separation anxiety, how many of you, if it existed, would really just be asking for the magic pill that was going to make that separation anxiety go away. It doesn't exist. Buzzkill,” Pachel said with a laugh. “But we do have some amazing therapies that we have the opportunity to learn about.”

First, it’s important to start off with a proper diagnosis of separation anxiety before considering any medication. Pachel also noted that even if you decide to move forward with a prescription, the medication should be used within a treatment plan that includes other management methods such as behavior modification strategies and safety tips for owners.

To diagnose, symptoms such as destruction, vocalization, and elimination would normally be present with separation anxiety. To further confirm the diagnosis, a patient history can be taken and a record of responses to any previous intervention. Pachel usually asks his clients the following questions to gather more information about the case:

• Is separation anxiety the only thing going on for this animal?
• Are we treating separation anxiety and noise phobia and other fear-based behaviors and compulsive disorder?
• Is it frequent or situational with certain triggers?
• How far in advance do you know you need to leave? Are you someone who operates on a regular schedule? (Do you always leave the house at 8 AM?)
• If your dog is distressed, what do they do? Are they very quietly shutting down? Trembling? Are they hyper salivating? Are they urinating and defecating? Are they highly active and ripping down the curtains or scratching at the door?

These are just some of the questions you could be asking, but the more thorough you are, the better. Getting a complete understanding of your patient and their needs will help you more accurately diagnose the separation anxiety. This can also help determine if medication can be used in conjunction with other management therapies.

One nonpharmacological option from Zomedica is the Calmer Canine device. This technology can deliver microcurrents of targeted pulsed electromagnetic field (tPEMF) signals to the area of the brain involved in controlling emotions such as anxiety. This aims to return a stressed brain to a more balanced emotional state.

If utilizing medications is the right fit for your patient, then where should you start? Pachel explained to attendees that there are currently 2 FDA approved drugs for long-term separation anxiety management: fluoxetine (Reconcile; PRN Pharmacal) and clomipramine (Clomicalm; Virbac). Pachel also recommended paroxetine and sertraline. For short-term use, Pachel recommended trazodone, clonidine, benzodiazepines, acepromazine, or dexmedetomidine oromucosal gel (Sileo; Zoetis), which is FDA approved for canine noise aversion.

“It's not a one size fits all, but we do have the opportunity to lean on these medications while we're thinking about supporting these animals most effectively,” Pachel reminded attendees.

“I would say the other options, the one that I've listed at the top with fluoxetine, paroxetine, sertraline, clomipramine, and venlafaxine, I'm much more likely to reach for those as first line standalone maintenance therapy,” he added.

However, Pachel also recommended tailoring your medication prescription to treat presenting symptoms. “If I've got an animal that has hyper salivation, or perhaps loose stools, or urine leakage as part of their clinical signs, potentially leveraging some of that anticholinergic side effect profile could be helpful utilizing paroxetine, and of the SSRIs that we're talking about here, paroxetine is the one most likely to do that,” he stated as an example.

Pachel also clarified that prescribing medication should fall into either a category of “maintenance” of the separation anxiety or “situational” if this behavior comes up with certain events. Maintenance would be for patients that are triggered frequently or if triggers are unavoidable. An example of this would be if a client leaving for work every day triggers anxiety for the pet, however this event is frequent and unavoidable. A situational approach would be for patients that are usually triggered by a predictable event or are typically infrequent. An example of this would be if a pet gets anxiety from loud noises such as fireworks or thunderstorms. These 2 categories could possibly be used together if needed, according to Pachel.

His general recommendation for maintenance of separation anxiety is to prescribe for a daily use, given 1-2 times a day for 3 to 4 weeks at onset of action/behavior. However, this should also be tailored to your patient and their needs. Situational should be first given at a low dose to trial the tolerance. Advise clients to observe their pet on the drug and report response. Then, use the medication at onset of the triggering event and monitor the fear, anxiety, and stress response. Is it better, worse, or unchanged?

“Now, one of the questions that often comes up as well is let's say you started a patient on one of these medications and it's not working, how do you transition? How do you move from one to the next? And the answer in almost every case is, it depends. But what does it depend on? It depends on urgency; how urgently do we need to get to a new medication? Do we have an opportunity here to titrate or taper down very, very slowly to observe whether that patient even still needs to be on one of these medications? Or trying to get data about what they look like when they're off medication,” Pachel said.

Helping animals with separation anxiety is not just an act of compassion, but a crucial step towards ensuring their overall well-being and quality of life. “We can turn sad, anxious faces into a much happier, more relaxed, and less stressed sort of an animal,” Pachel said.

Reference

Pachel C. Prescribing for separation anxiety. Presented at: Fetch dvm360 conference; Nashville, TN; May 17, 2024.