Environmental management alone is impractical, and complete compliance is difficult in patients with numerous triggers, as with Luna and most patients with this set of diagnoses. Anxiolytic medication is thus necessary. Medical therapy is often multimodal, targeting ≥1 neurotransmitters (NTs) involved in fear and anxiety and includes serotonin (ie, coping NT), dopamine (ie, pleasure/activation NT), γ-aminobutyric acid (ie, inhibitory NT), and norepinephrine (ie, NT involved in fight/flight modulation).
Treatment for dogs with chronic PTSD and other phobias can be challenging, and the correct medications and products are needed for behavior modification.
Luna was started on the following:
- Sertraline (25 mg twice daily [≈1 mg/kg PO every 12 hours]), which was chosen because it is a selective serotonin reuptake inhibitor that targets serotonin and dopamine increases via inhibition of reuptake in the postsynaptic cleft.1 In humans, sertraline is approved for use in patients with PTSD and social phobias.2-4
- Alprazolam (1-3 mg PO prior to or immediately after any panic-inducing situation [≈0.04-0.1 mg/kg PO every 6-8 hours as needed]), which is shown to be effective in treating dogs with noise phobia and often useful for treatment of other phobia disorders (eg, noise phobia)5,6
- α-casozepine (450 mg; used as directed based on patient weight), which is used for calming effects in dogs with anxiety disorders7
- Pheromone collar (used as directed by the manufacturer); maternal-appeasing pheromones have been shown to help dogs with noise phobias and other anxiety disorders (eg, travel anxiety).8-10
Nutraceuticals and pheromones may augment medical therapy and potentially improve outcomes when combined with other treatment modalities.11
After 4 weeks, sertraline was increased to 50 mg twice daily (≈2 mg/kg PO every 12 hours) based on an ≈60% reduction in intensity of fear and anxiety, as well as a continued need for improvement. All other drugs and products were continued at the starting dosages. Luna’s owners reported a decrease in the intensity of reactions to triggers and slightly decreased time of recovery, but attempts at DSCC were still unsuccessful. Management was still difficult due to the numerous triggers Luna experienced daily; this was partly due to living in an apartment complex in a major metropolitan area and the need to walk Luna for elimination purposes on a busy street.