The goal of treating separation anxiety is to reduce a dog’s dependence on its owners. This greater sense of independence can be accomplished with a variety of behavior modification activities often in conjunction with antianxiety drugs.
BEHAVIOR MODIFICATION POINTERS
Owners should not respond in any way to a pet’s attempts to get attention from them by such behaviors as barking, whining, jumping up and pawing. They should not look at, talk to or touch the dog at times when it is exhibiting these attention-seeking behaviors. Warn owners to expect the behavior to initially get worse and more physical.
Have the owners ignore the dog for 30 minutes before leaving the house. This is meant to prevent inadvertent reinforcement of anxious behavior as they prepare to leave. About five to 10 minutes before departure, the owners can give a toy stuffed with a treat to distract the dog away from the act of the owners departing from the home.
The underlying directive here is for the owners to ignore the dog upon arrival until it is relaxed. They shouldn't interact with or even acknowledge the dog.
Use of punishment
The owners should not use physical or verbal punishment in response to destructive behavior or elimination. These behaviors are clinical signs of anxiety, so punishment, especially after the fact, will increase the dog’s anxiety level.
Uncoupling departure cues
This process is essentially habituation, or consistent exposure to a stimulus such that it no longer elicits the response. The owners should make a list of activities they perform before leaving home that signal they are leaving and result in the dog getting more and more anxious. Have the owners perform these activities when they have no intention of leaving the home so there is less of an association with the impending departure.
Indoor relaxation exercises
Have the owners train the dog to assume a calm, relaxed behavior during gradually increasing periods of separation. This exercise is commonly done when moving casually from room to room. It often helps to have a dog bed or mat that the dog is comfortable lying on.
The owners begin by moving a short distance from the dog and then returning and rewarding it with attention or a treat. They should repeat this distance until it is clear that the dog is very relaxed and then gradually increase the distance until the owners are near the exit of the room. Again, each step should be repeated until the dog is clearly comfortable with each level of departure.
Finally, once the owners can go out of sight of the dog, they can gradually increase the time that they are not in sight of the dog in the same way they were increasing distance. The owners should never force the dog to remain behind when they leave the room if they have not worked up to that level of departure.
Graduated departure exercises
Have the owners train the dog to assume calm, relaxed behavior during gradually increasing periods of separation as they leave the home. Because this can be a very slow process, and because the owners will likely need to leave the home for longer periods before the dog is ready (thus disrupting the desensitization process), they may need a “bridge” cue to signal “safe” departures. This involves using a signal, cue or marker so that the dog realizes that these practice departures are just that—only practice and not the real thing.
So each time the owners are doing practice departures, they can use an associated cue or marker to signal this fact and then, once they have worked up practice departures to a time frame of around one to two hours (during which most dogs with separation anxiety typically have issues), they can use the cue during actual departures to function to “bridge” from practice to actual departures. Typical bridge markers can be olfactory (a unique scent such as a new air freshener that can be sprayed at the outset of each training session), auditory (e.g. the sound of a clicker) or visual (a certain light used only during training).
Consistent exercise in the form of walks and play can reduce anxiety by decreasing the dog’s focus on the owners’ departure from the home.
The judicious use of medication can decrease a dog’s overall anxiety level and enable it to respond better to the behavioral tasks just outlined.
This tricyclic antidepressant (TCA) primarily elevates serotonin and norepinephrine concentrations in the synaptic cleft of brain neuropathways. The initial dose range in my practice is 1 to 4 mg/kg bid. This dose is higher than the label dose, but it is not uncommon to use doses higher than label recommendations to get a satisfactory response. As always, start at the lower end of the dose range and wean upward to the desired effect.
Allow at least two to four weeks for the onset of action before making dose adjustments. Sedation and anorexia are common. Increased anxiety, aggression and hepatic disturbances are less common. Clomipramine can also lower the seizure threshold in dogs with a previous history of seizures.
Perform a complete blood count (CBC), serum chemistry profile and thyroid panel before starting treatment. Repeat the CBC and serum chemistry profile about four to six weeks after treatment has been initiated. Once the signs of separation anxiety have demonstrated significant improvement, allow an additional two to three months and then begin weaning the dog from the drug by decreasing the dose by 25 percent every three to four weeks until the dog is safely off the medication or when clinical signs return. If signs recur, return to the previously effective dose.
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that affects serotonin only, not other neurotransmitters. The dose is 1 to 2 mg/kg once a day. Allow at least six to eight weeks for the onset of action. Sedation and anorexia are common side effects. Increased anxiety, aggression and hepatic disturbances are less common.
The monitoring and weaning process are similar to that of clomipramine. Perform a complete blood count (CBC), serum chemistry profile and thyroid panel before starting treatment. Repeat the CBC and serum chemistry profile four weeks after treatment has been initiated. Once the signs of separation anxiety have demonstrated significant improvement, allow an additional two to three months, and then begin weaning the dog from the drug by decreasing the dose by 25 percent every three to four weeks until the dog is safely off the medication or when clinical signs return. If signs recur, return to the previously effective dose.
Benodiazepines such as diazepam, alprazolam and clorazepate are typically used in dogs with separation anxiety to treat panic behavior seen at time of departure to help ease the transition. All have a short onset and short half-lives and are used in conjunction with TCAs and SSRIs.
Trazodone is a serotonin agonist at the 5HT1A receptor and a weak serotonin reuptake inhibitor. It is unclear which of these effects is responsible for the reduction in anxiety that occurs with its use. The dose is 1 to 3 mg/kg either as needed or up to three times a day. Begin at the low end of the dose range for three days, and then increase the dose gradually as needed.
Trazodone can be used along with an SSRI or a TCA, but be sure to monitor for possible side effects, which include drowsiness, nausea and vomiting, headache and dry mouth, dizziness, constipation and urinary retention. Hypotension, tachycardia, syncope and arrhythmias can also occur. Initiating therapy at the low end of the dose range for three doses and then gradually weaning up the dose can help minimize the impact of these side effects. Trazodone can be given as needed, one to two hours before departure or up to three times a day. Do not exceed about 16 mg/kg total daily dose.
FACTORS AFFECTING OUTCOME
The older the patient at the time of onset or presentation, the poorer the prognosis. Multiple behavioral diagnoses will decrease the prognosis. Success relies on the owners’ ability to follow through on recommendations and administer the medication as well as the patient’s response to that medication. Also consider quality of life issues for the owner, the damage done to property and whether relations with neighbors are being affected when determining a prognosis.