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Storm Phobias


DVM360 MAGAZINE


Alprazolam is a true panicolytic drug, meaning that it can also stop a panic attack. So if clients find the dog or cat in distress, giving a whole dose and then evaluate what to do 15-30 minutes later can really work because the panic will be lysed within a relatively short period of time.

Cats do better with alprazolam than diazepam because they have a very slow metabolic rate for nordiazepam, the sedating intermediate metabolite of diazepam. Because the intermediate metabolites of alprazolam are hydroxylated, this may be a safer BZ with cats who may be compromised or who are slow metabolizers than is diazepam.

I know that the common "treatment" for storm and noise phobias and veterinary office visits is acepromazine. In truth, I wish this medication would be placed at the far back of a top shelf and used only exceptionally. Acepromazine is a dissociative anesthetic meaning that it scrambles perceptions. Ask yourself if a scrambling of perceptions will make an anxious or uncertain dog worse or better. It's always worse, and we make many if not most dogs more sensitive to storms by using this drug. In part this is also because sensitivity to noise is heightened.

This is a recipe for disaster for these dogs, and, in fact, they learn to be more fearful and more reactive because of these associations. If what you need is sedation - acepromazine can be an acceptable adjuvant, but it makes most of my really fearful and really reactive patients worse, so all sorts of other drug combos can work better and do less harm than is done by the routine use of acepromazine.

Finally, if the dog or cat calms using alprazolam or another BZ, the clients should be encouraged to do four things:

  • They should ensure that they are treating any co-morbid anxieties (e.g., separation anxiety, generalized anxiety disorder, most aggressions) with an appropriate tricyclic antidepressant or selective serotonin re-uptake inhibitor, plus the chosen BZ.
  • The clients should not pet the dog or cat and tell him or her that it is okay. The animal knows it's not okay and such contradictory signals, especially in profoundly obedient pets, increase anxiety. Instead, just talk normally to them, and press firmly, or lie next to them without petting. Such behavior provides closeness and allows the pet's muscles to relax without inadvertently rewarding any of the signs of anxiety.

Clients should work with behavior modification designed to teach the dog or cat to relax when there is no problematic stimulus so that they can start to transfer the learned lessons of physical and physiological relaxation to situations that are provocative.

Clients should have a benign, but clear, rule for how animals will be handled if they become upset or panicked. This will help the client, and it will really help the pet. For example, if a sudden storm surprises us in the night, one of us will take our storm phobic dogs from the room in which they sleep, get the alprazolam, give it immediately, and lead them to the spare bedroom where whomever gets up first will sleep with them. This room is better insulated from noise and storm pyrotechnics and is super-well air-conditioned to remove humidity. The process of removing the dogs from their room and giving the medication takes less than 5 minutes. Within minutes of that we are in bed with them, and last week, both were asleep five minutes later. That's not the medication, alone: that's the learning of the pattern that everything will be okay because it has become okay. That's the benefit of the BZ, alprazolam: the dogs can still learn, and if they are physiologically distressed, such distress is chemically blunted so no or little learning occurs about how to become better distressed during the storm. In this case, medication facilitates complex associative learning about how to relax.

I failed Susie by not making treatment with medication a requirement for her adoption to a foster family. So, in memory of Susie, a wonderful, wonderful dog, I offer this column in the hope that other animals cease to suffer because their people stopped fearing drugs.


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Source: DVM360 MAGAZINE,
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