The goal of noise phobia treatment is not to sedate the dog but to stop its distress while helping the animal act as normal
as possible. Medications can be used on an as-needed basis in addition to maintenance medications such as TCAs and SSRIs.
In fact, we now know that many dogs with separation anxiety also react to noises, and most animals that react to noises are
at risk for developing other anxieties. If both of these or any other comorbid conditions are not treated, the dog's behavior
For example, many dogs with separation anxiety will need a TCA or SSRI daily and alprazolam only if there's a storm. Meanwhile,
others have a component of panic to their response to being left. In this case, the dog also will need alprazolam any time
it's left, preferably before it begins to become distressed. This may mean that some dogs will need to be given alprazolam
every time they experience an anxiety-inducing situation or stimulus. If the medication and dosage are helping the dog, that's
great, but assessment is critical. For dogs that have concomitant anxieties or anxiety-related problems, or for those whose
noise phobia is profound, maintenance medication designed to reduce the animal's overall reactivity and anxiety, and to raise
the threshold for a reaction involving panic, is recommended.2 This means treating the dog daily with a TCA or SSRI.
Again, clients must be able to assess the dog to see if the medication is making it worse (e.g., more incidents, greater intensity),
making it better (e.g., fewer incidents, lesser intensity) or having no effect. By keeping daily logs and routinely videotaping
the dog, a client will be able to note changes in many anxiety-related behaviors, including destruction, elimination, self-mutilation
and barking. Panting and more subtle behaviors may require that clients be present to observe.
Regardless, instruct the client to pick some subset of the behaviors the dog exhibits when distressed and monitor these for
change. The information you and the client gain will help with management of the dog's medication.
Clearance of these medications is through liver (hepatic glucuronidation pathways) and kidney excretion, so knowing these
pathways aren't impaired is important if we are to avoid side effects and minimize risk. Learn about the animal's ability
to metabolize the drugs by taking a blood sample and looking at serum kidney and liver enzyme activities. All TCAs affect
the reuptake of serotonin and norepinephrine, and the extent to which they do this for each catecholamine depends on the specific
TCA. The desirable effect is the one associated with reuptake inhibition for serotonin; anxiety has been associated with low
levels of serotonin. The SSRIs primarily affect serotonin, and most are relatively specific for one class of receptor, the
5HT1A subtype, thought to be involved in many anxiety-related conditions.
When considering the combined use of TCAs or SSRIs with benzodiazepines for dogs with two diagnoses or profound, daily noise
reactivity, the first medication of choice may be amitriptyline (1 to 2 mg/kg orally every 12 hours for 30 days to start)
because it's inexpensive and nonspecific and will show an effect within a month. However, amitriptyline's lack of specificity
for certain receptors means it's often not the best medication by itself unless the problem started recently.
If amitriptyline fails to provide appropriate relief, or if the dog is severely affected or has been affected for some time,
more specific medications may help. Fluoxetine (Reconcile—Eli Lilly;1 mg/kg orally once a day for eight weeks to start) is
an SSRI. It has almost no effect on adrenaline and, hence, potentially fewer side effects than TCAs. But because it also changes
the metabolism of the neuron through alterations in receptor conformation, it's impossible to evaluate efficacy for a minimum
of six to eight weeks.
Clomipramine (Clomicalm—Novartis; 1 mg/kg orally t.i.d. for 14 days, then 2 mg/kg t.i.d. for 14 days, then 3 mg/kg t.i.d.
for 28 days to start) is a TCA that's similar to SSRIs such as fluoxetine, except it does have effects on adrenaline, which
is where many of the side effects come from. Clomipramine is best suited for conditions primarily involving anxiety and ritualistic
behaviors, whereas fluoxetine may be best suited for conditions involving reactivity and impulsivity.
Another medication that can be considered is sertraline (1+ mg/kg orally either once or twice per day). This human SSRI has
been used in dogs to treat a variety of behavior-related conditions including anxiety and obsessive-compulsive behaviors.
Its limited use in dogs makes it difficult to compare to other SSRIs.