How to manage anxiety in pets

By Chelsea McGivney, DVM, MBA

Anxiety is among the most underdiagnosed conditions in everyday companion animal practice, and one of the most consequential. A study analyzing more than 32 million canine medical records across primary care hospitals in the United States found behavior problem labels increased tenfold between 2010 and 2020, from one percent to more than 10 percent of records, yet psychoactive medications were prescribed in only a small fraction of those cases.¹ The gap between prevalence and treatment reflects a real challenge: many veterinarians feel underprepared to navigate behavioral pharmacology, and many clients do not realize help is available.

The stakes go beyond quality of life. Anxious patients are harder to examine, increasing the risk to staff and compromising diagnostic accuracy. Untreated anxiety can contribute to house-soiling, destructive behavior, self-trauma, and ultimately, relinquishment or euthanasia. For veterinarians who want to bridge that gap, a working familiarity with the most commonly used anti-anxiety medications and where supplements fit in is an increasingly essential clinical skill.

Understanding what you are treating

Before reaching for a prescription pad, it helps to categorize the anxiety. Broadly speaking, companion animal anxiety falls into two types:

• Situational (acute) anxiety is triggered by predictable events (e.g., veterinary visits, car travel, thunderstorms, fireworks, or grooming). These cases respond well to short-acting, as-needed medications.
• Chronic or generalized anxiety: Persistent baseline anxiety, separation-related distress, or anxiety that underlies many behavioral problems. These cases benefit from long-term, daily medication paired with behavior modification.

The distinction shapes the entire treatment approach, including which drug class to reach for, how to dose, and what to tell clients about expectations.

Daily medications for chronic anxiety

For patients with persistent anxiety, separation distress, or anxiety-driven behavioral disorders, the first-line options are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). These medications require weeks to reach full efficacy and are most effective when paired with a behavior modification plan.

• Fluoxetine is a widely prescribed SSRI in veterinary medicine and is the only FDA-approved behavioral medication for canine separation anxiety when combined with behavioral modification (available under the brand name Reconcile). Typically dosed at 1–2 mg/kg orally once daily in dogs and cats, research combining fluoxetine with a behavior modification program demonstrated significant clinical improvement within one to two months, with norfluoxetine levels correlating with therapeutic outcomes.² A survey of veterinarians confirmed its off-label, broad use across anxiety, aggression, compulsive disorders, and phobias in both species.³ Owners should be counseled to expect a four- to six-week lag before meaningful behavioral improvement and to maintain behavior modification throughout. SSRIs as a class can suppress appetite, so fluoxetine may not be the best first choice for patients that are already inconsistent eaters; an alternative agent should be considered in those cases.
• Clomipramine is another FDA-approved option for canine separation anxiety. A TCA that primarily inhibits serotonin reuptake, it is dosed at 1–2 mg/kg orally twice daily in dogs and has also been used off-label in cats. Clomipramine has demonstrated efficacy for both separation anxiety and noise phobia when combined with behavioral therapy.⁴ Anticholinergic side effects are more pronounced than with SSRIs, which should factor into patient selection.
• Sertraline is frequently utilized off-label in both canine and feline patients to address generalized anxiety, compulsive disorders, and fear-driven aggression.^5,6 As with all SSRIs, a commitment to the long-term timeline is critical; treatment failure is often precipitated by owners who, expecting immediate behavioral shifts, discontinue therapy before the medication has reached therapeutic levels. 

  

As-needed medications for situational anxiety

For predictable, short-duration stressors, the goal is fast onset, manageable sedation, and reliable anxiolysis. Four drug classes dominate this category: trazodone, gabapentin/pregabalin, benzodiazepines, and alpha-2 agonists.

• Trazodone has become the most commonly prescribed veterinary anxiolytic for situational use. A serotonin antagonist and reuptake inhibitor (SARI), it is dosed at approximately 4–12 mg/kg orally in dogs 90 minutes before anticipated stressors. In a randomized, double-blind, placebo-controlled crossover trial, dogs treated with trazodone showed significantly lower stress scores during veterinary visits, with improved heart rate variability and respiratory rates compared to placebo, and notably, owner stress also decreased.⁷

Trazodone has also been used to facilitate post-operative confinement in orthopedic patients and as part of pre-anesthetic protocols.⁸ Common side effects include sedation, vomiting, and paradoxical excitement, with geriatric patients being more sensitive.

• Gabapentin acts on voltage-gated calcium channels to produce reliable sedation and anxiolysis. Dosed at 100–200 mg per cat or 10–20 mg/kg in dogs orally two hours before a stressor, it has shown strong efficacy, particularly in felines.

A double-blind, randomized, placebo-controlled crossover trial demonstrated gabapentin significantly improved compliance in cats with fear-based aggression during veterinary examinations.⁹ A 2024 retrospective study found 72 percent of dog owners reported moderate or high effectiveness, with sedation as the most common side effect.¹⁰ The combination of trazodone and gabapentin produces more profound sedation than either agent alone in cats¹¹ and dogs, making this combination a useful option for highly anxious patients.

• Pregabalin has emerged as a promising option, particularly for feline anxiety. A placebo-controlled field study of 209 cats found a single oral dose of 5 mg/kg administered 90 minutes before transport significantly decreased both travel- and visit-related anxiety, with good owner compliance due to the small dosing volume.¹²
• Benzodiazepines, such as alprazolam and lorazepam, offer a rapid onset and short duration, making them useful for acute events. However, the risk of paradoxical excitement, dependence on repeated dosing, and, in cats, rare but serious hepatotoxicity with oral diazepam means they are not first-line choices for most practitioners. When used, it is recommended to administer at least one hour before the anticipated stressor.
• Tasipimidine oral solution (Tessie) is a newly approved FDA medication and the first drug specifically indicated for both canine noise aversion and separation anxiety.¹³ An alpha-2 adrenergic agonist administered transmucosally, Tessie is applied between the cheek and gum approximately 30 minutes before a predictable anxiety-provoking event or prior to the owner's departure. Unlike traditional sedatives, dexmedetomidine provides anxiolysis with minimal impairment of motor function at labeled doses. Clinical studies demonstrated significant reductions in anxiety-related behaviors associated with both noise triggers and separation-related distress, making it a valuable option for dogs whose anxiety is episodic but recurrent. Common adverse effects include transient lethargy, bradycardia, and gastrointestinal upset, and it should be used cautiously in patients with significant cardiovascular disease. 

  

Where supplements fit in

The nutraceutical market for pet anxiety is growing rapidly, and clients will ask about these products, often before they ask about prescription medications. Pet food companies are increasingly incorporating anxiolytic ingredients into therapeutic diets, while standalone supplements continue to expand the available options. A working knowledge of the evidence helps practitioners guide these conversations honestly.

• L-theanine, an amino acid found in green tea, has anxiolytic effects mediated through glutamate receptor binding and increased GABA activity. An open-label, multicenter field study found L-theanine supplementation reduced stress-related signs in cats, including inappropriate elimination, fear-based aggression, and hypervigilance.¹⁴ Randomized controlled data in dogs suggest benefits for some anxious behaviors, though effect sizes are generally smaller than those of prescription medications.¹⁵
• Alpha-casozepine, a bioactive peptide derived from bovine milk protein, has mild GABA-A receptor affinity. A study combining an alpha-casozepine and L-tryptophan-supplemented diet found reduced anxiety behaviors in fearful cats across multiple test paradigms compared to controls.¹⁶
• Melatonin is frequently recommended for noise aversion and situational anxiety, particularly in dogs. Evidence remains limited to smaller studies and clinical experience, but it is generally well tolerated and inexpensive, making it a reasonable adjunct when cost is a concern.
• Cannabidiol (CBD) warrants honest conversation with clients. Despite widespread enthusiasm, a controlled trial using a fireworks noise model found 1.4 mg/kg/day of CBD did not produce measurable anxiolytic effects in dogs–trazodone alone performed better.¹⁷ Pharmacokinetic data also show significantly lower oral bioavailability in cats than in dogs, and one cat in a 12-week safety study developed a persistent ALT elevation.¹⁸ Until more robust efficacy and safety data are available, CBD should be discussed with appropriate transparency.
• Probiotics represent an emerging frontier in companion animal behavioral medicine, rooted in the gut-brain axis. In a blinded, placebo-controlled crossover study, dogs supplemented with BL999 showed significant reductions in anxious behaviors, along with decreased salivary cortisol and improved heart rate variability, compared with placebo.¹⁹

A Colorado State University study in cats found similarly reduced cortisol levels and increased social interaction during stress.²⁰ A calming supplement is available in the market to be administered as a daily powder mixed into food, with full effect reportedly typically seen at six weeks, and works best as part of a multimodal plan rather than as a standalone treatment.²¹

Making multimodal work in practice

The most important message for clients–and the one that most influences outcomes–is medications and supplements are tools, not cures. No prescription works as well alone as paired with environmental management and behavior modification. For separation anxiety, desensitization and counterconditioning are essential components of any treatment plan; for noise phobia, management strategies (i.e., white noise, safe spaces, desensitization recordings) amplify pharmacologic effects.

Practical tips for client communication:

• Frame daily medications as a long-term investment with a realistic timeline of four to eight weeks to full effect and plan to continue them for at least six months beyond resolution of clinical signs before considering a taper.
• Set the expectation that situational medications may need dose adjustment over one to two trials.
• Provide clear written instructions that include dose, timing relative to the stressor, and what side effects to watch for.
• Schedule a recheck at four to six weeks for animals on daily medications; use standardized questionnaires (e.g., C-BARQ for dogs) to track progress objectively.
• Normalize the conversation: behavioral health is health, and raising it at wellness visits removes the stigma that delays early intervention.

A rapidly evolving field

Behavior problem labels in primary care canine records grew tenfold in a single decade, yet prescribing rates remained a fraction of what that prevalence demands.¹ That gap is not a knowledge problem so much as a practice culture problem, and general practitioners are best positioned to close it. The tools outlined here are more evidence-based than ever and integrating behavioral screening into routine wellness visits may be the highest-yield single change a practice can make for patient welfare.

As behavioral science continues to converge with gut microbiome research and neurophysiology, new targets for intervention are emerging that may reshape how veterinarians approach anxiety treatment in the coming decade.²¹ The foundation built today through thoughtful medication selection, clear client communication, and a multimodal mindset positions every general practitioner to be a meaningful participant in that future.

Chelsea McGivney, DVM, MBA, attended veterinary school at Colorado State University. She has practiced general medicine, emergency medicine, and in-home end-of-life veterinary care. Currently, Dr. McGivney is the executive director of operations of Caring Pathways, a multi-practice in-home end-of-life veterinary company focused on providing compassionate hospice and palliative care, as well as in-home euthanasia at life's end.

References

1. Weng HY, Morrison JA, Topdjian K, Ogata N. Real-world data on behavioral practices for dogs in primary care veterinary hospitals in the United States (2010–2020). J Am Vet Med Assoc. 2025;263(7). doi:10.2460/javma.24.06.0412
2. D'Angelo A, Bellino C, Rendini D, et al. Behavioral therapy and fluoxetine treatment in aggressive dogs: a case study. Animals. 2020;10(5):832. doi:10.3390/ani10050832
3. Kaur G, Schmidt PL, Voith V. The use of fluoxetine by veterinarians in dogs and cats: a preliminary survey. Vet Rec Open. 2016;3(1):e000146. doi:10.1136/vetreco-2015-000146
4. Seksel K, Lindeman MJ. Use of clomipramine in treatment of obsessive-compulsive disorder, separation anxiety and noise phobia in dogs: a preliminary, clinical study. Aust Vet J. 2001;79(4):252–256. doi:10.1111/j.1751-0813.2001.tb11976.x
5. Dubé MB, Denenberg S. Tools for managing feline problem behaviours: Psychoactive medications. J Feline Med Surg. 2018;20(11):1034–1045. doi:10.1177/1098612X18806760
6. Overall KL. Paradigms for pharmacologic use as a treatment component in feline behavioral medicine. J Feline Med Surg. 2004;6(4):193–204. doi:10.1016/j.jfms.2003.09.009
7. Kim SA, Borchardt MR, Lee K, Stelow E, Bain M. Effects of trazodone on behavioral and physiological signs of stress in dogs during veterinary visits: a randomized double-blind placebo-controlled crossover clinical trial. J Am Vet Med Assoc. 2022;260(8):928–935. doi:10.2460/javma.20.10.0547
8. Hamilton A, Sherman B, Griffith E, Gruen M, Roe S. Use of trazodone to facilitate postsurgical confinement in dogs. J Am Vet Med Assoc. 2014;245(3):296–301. doi:10.2460/javma.245.3.296
9. Kruszka M, Graff E, Medam T, Masson S. Clinical evaluation of the effects of a single oral dose of gabapentin on fear-based aggressive behaviors in cats during veterinary examinations. J Am Vet Med Assoc. 2021;259(11):1285–1292. doi:10.2460/javma.20.06.0307
10. Waring CT, Herron M, Kirby-Madden T. Effects of gabapentin on the treatment of behavioral disorders in dogs: a retrospective evaluation. Animals. 2024;14(10):1462. doi:10.3390/ani14101462
11. Tucker LE, Sanchez A, Valverde A, et al. Evaluation of the sedative properties of oral trazodone, gabapentin or their combination in healthy cats. J Feline Med Surg. 2024;26(10). doi:10.1177/1098612X241281481
12. Palestrini C, Aspegren J, Overall K, Korpivaara M, Lamminen T. Pregabalin alleviates anxiety and fear in cats during transportation and veterinary visits—a clinical field study. Animals. 2023;13(3):371. doi:10.3390/ani13030371
13. U.S. Food and Drug Administration. FDA approves first drug to treat noise aversion and separation anxiety in dogs. FDA Center for Veterinary Medicine. May 6, 2026. Accessed June 10, 2026.  FDA approval announcement
14. Navarro C, Reme C, Nicolas CS, et al. Effect of l-theanine tablets in reducing stress-related emotional signs in cats: an open-label field study. J Feline Med Surg Open Rep. 2018;4(2). doi:10.1186/s13620-018-0130-4
15. Cannas S, Tonini B, Bela B, et al. Effect of a novel nutraceutical supplement (Relaxigen Pet dog) on the fecal microbiome and stress-related behaviors in dogs: a pilot study. J Vet Behav. 2020;42:66–75. doi:10.1016/j.jveb.2020.09.002
16. Milgram B, de Rivera C, Landsberg G, Mougeot I, Kelly S. Therapeutic effects of an alpha-casozepine and L-tryptophan supplemented diet on fear and anxiety in the cat. J Feline Med Surg. 2016;18(9):745–750. doi:10.1177/1098612X16669399
17. Harmon D, Spangler DM, Morris EM, et al. The impact of feeding cannabidiol (CBD) containing treats on canine response to a noise-induced fear response test. Front Vet Sci. 2020;7:569565. doi:10.3389/fvets.2020.569565
18. Deabold KA, Schwark W, Wolf L, Wakshlag J. Single-dose pharmacokinetics and preliminary safety assessment with use of CBD-rich hemp nutraceutical in healthy dogs and cats. Animals. 2019;9(10):832. doi:10.3390/ani9100832
19. McGowan RTS. Tapping into those gut feelings: impact of BL999 (Bifidobacterium longum) on anxiety in dogs. Presented at: American College of Veterinary Behaviorists Symposium; 2018. Available at: https://www.fearfree.com/wp-content/uploads/2024/07/Ragen-McGowan-2018-VBS-Abstract.pdf
20. Purina Institute / Colorado State University. BL999 feline stress study summary. Purina Nutrition Exchange. July/August 2022. Available at: https://assets.ctfassets.net/4dmg3l1sxd6g/6r98D7Eqg56l5cSfesz1fB/8791dff6143ca541eab58464af0d55f1/NutritionExchangeInsert_JulyAugust_2022.pdf
21. https://www.purina.ca/purina-pro-plan-veterinary-diets/supplements/calming-care
22. Sacoor C, Marugg JD, Montezinho L, Empadinhas N, Lima NR. Gut-brain axis impact on canine anxiety disorders: new challenges for behavioral veterinary medicine. Vet Med Int. 2024;2024:2856759. doi:10.1155/2024/2856759