Anxiety and Fear-Related Behaviour in Dogs

What you might notice

• Panting, pacing, trembling or drooling when there is no heat and no exercise to explain it
• Hiding - behind the toilet, under the bed, in a closet, in the bathtub - or trying to get into a small dark space
• Trying to escape: scratching at doors, digging at the carpet, chewing door frames, pushing at windows
• Ears pulled back and held toward the back of the head, body low, tail tucked, whale-eye (whites showing)
• Barking, howling or whining that starts within minutes of you leaving and does not settle
• Chewing, digging or toileting indoors that happens only when your dog is alone, never when you are home
• Refusing food or treats he would normally take instantly - a reliable sign a dog is over threshold (over threshold means so frightened he can no longer learn, eat or respond to you; the goal of every plan on this page is to keep him under that point)
• Clinging to you, following you room to room, or getting agitated as you pick up keys or put on shoes
• Freezing, refusing to walk past something, or turning for home partway through a familiar route
• Scrambling into cupboards, bins, handbags or bedside drawers during a panic - frightened dogs have swallowed their owner's tablets, their own whole bottle of medicine, chocolate, vapes or xylitol-sweetened 'calming' chews this way. Treat a raided cupboard as a possible poisoning, not just a mess.
• Panting that does not stop once the noise is over, especially in warm weather or after struggling in a crate, car or closed room - this is the point where fear can become heatstroke, and it is the sign most often dismissed as 'just anxiety'

Standard of care

1. Find and treat pain and medical disease before you call it behavioural

   Controlled trial in this species

   Do a full physical, orthopaedic and neurologic exam and screen for pain as a routine part of the behavioural workup. Where pain is suspected but no lesion is identified, run a documented trial of analgesia and re-score the behaviour. It is one of the most commonly skipped steps in the workup - but note the grade: this is expert consensus from a referral caseload, not a controlled trial, and no study anywhere ranks the management steps on this page against each other by yield. Prescribe the analgesic yourself and say out loud which one: owners who are told 'try pain relief' without a named canine product reach for ibuprofen or acetaminophen.

   Narrative review of the authors' own recent canine behaviour caseloads - a review of 100 recent dog cases across multiple veterinary behaviourists - yielding a conservative estimate of around one third of referred cases involving some form of painful condition, with the figure approaching 80% in one contributing caseload. Design limits that set the tier: no control group, no denominator, self-selected tertiary-referral population, and the ~80% figure is the upper end of an individual clinician's caseload rather than a series prevalence. Musculoskeletal, gastrointestinal and dermatological pain were all commonly relevant. The authors explicitly recommend evaluating response to trial analgesia when pain is suspected, even absent a specific physical lesion, and that recommendation is what this step rests on.

   Mills DS, Demontigny-Bedard I, Gruen M, Klinck MP, McPeake KJ, Barcelos AM, et al. Pain and Problem Behavior in Cats and Dogs. Animals (Basel). 2020;10(2):318. PMID 32085528; DOI 10.3390/ani10020318

2. Reward-based behaviour modification is the foundation - both FDA-approved maintenance drugs are licensed only on top of it

   Approved / guideline-backed

   Build a plan of trigger management (reduce exposure below threshold), systematic desensitisation and counter-conditioning, a predictable safe space the dog chooses himself and can leave freely, and reinforcement of calm behaviour. For the two daily drugs, pharmacotherapy is an enabler of this plan and not a substitute for it: the Reconcile client information sheet states it plainly, that the drug works by making the dog more receptive to the training programme and does not act as a sedative. Be precise about the third product: SILEO is licensed for a TRIGGER, not as an adjunct - its indication carries no behaviour-plan condition - so a behaviour plan alongside SILEO is a clinical recommendation, not a label requirement. Recommend it anyway, because nothing about a 5-dose event product changes the dog's underlying learning.

   Structural for two of the three products, not all three. The Clomicalm label reads 'to be used as part of a comprehensive behavioral management program' (NADA 141-120) and the Reconcile label reads 'in conjunction with a behavior modification plan' (NADA 141-272); the two separation-anxiety pivotal RCTs (King 2000, Simpson 2007) delivered behaviour therapy to every dog in every arm including placebo, so those published drug effects are effects ON TOP of behaviour modification. SILEO's indication by contrast is standalone - 'SILEO is indicated for the treatment of noise aversion in dogs' - and the dexmedetomidine pivotal trial (Korpivaara 2017, PMID 28213531) randomised drug against placebo with no behaviour-therapy arm described in either group. What can be said across all three: no trial on this page has shown a maintenance drug to work without behaviour modification, because none tested one that way. The 2015 AAHA Canine and Feline Behavior Management Guidelines make behavioural management a core practice competency.

   Hammerle M, Horst C, Levine E, Overall K, Radosta L, Rafter-Ritchie M, Yin S. 2015 AAHA Canine and Feline Behavior Management Guidelines. J Am Anim Hosp Assoc. 2015;51(4):205-21. PMID 26191821; DOI 10.5326/JAAHA-MS-6527

3. Use reward-based methods only - aversive training is associated with measurably worse welfare

   Controlled trial in this species

   No shock, prong or choke collars, no alpha rolls, no scolding or punishing a fearful or growling dog. Punishing a growl removes the warning without removing the fear. Direct owners to reward-based trainers and, for anything involving aggression, to a board-certified veterinary behaviourist. The direction of this recommendation is well supported and is echoed by the wider literature and by AAHA 2015; the grade below reflects study design, not doubt about the advice.

   92 companion dogs recruited from reward-based (n=42), mixed (n=22) and high-aversive (n=28) training schools, assessed by video-coded stress behaviour, salivary cortisol and a cognitive bias task. Dogs from aversive schools showed more stress-related behaviour, more tense and low behavioural states, more panting, greater post-training cortisol rises, and were more 'pessimistic' in the cognitive bias task than reward-trained dogs - i.e. the association held outside the training context as well as inside it. Design limit that sets the tier: dogs were NOT randomised to training method - owners self-selected their schools, and only seven schools contribute all the group-level variance, so school and owner characteristics are confounded with method. This is observational evidence, not a randomised trial.

   Vieira de Castro AC, Fuchs D, Morello GM, Pastur S, de Sousa L, Olsson IAS. Does training method matter? Evidence for the negative impact of aversive-based methods on companion dog welfare. PLoS One. 2020;15(12):e0225023. PMID 33326450; DOI 10.1371/journal.pone.0225023

4. Event-driven noise aversion (fireworks, gunshots): dexmedetomidine oromucosal gel (SILEO) - FDA-approved, but NOT evaluated for thunderstorms

   Approved / guideline-backed

   The only US FDA-approved product for noise aversion in dogs. 125 mcg/m2 applied to the oral mucosa between cheek and gum, dosed by the syringe's dot scale, given 30-60 minutes before an anticipated event or at the first sign of anxiety, repeatable up to five times per event with at least a two-hour pause between doses. It must be absorbed oromucosally - if the gel is swallowed it may not work - and an extra dose must never be improvised to 'top up'. Subsedative alpha-2 agonist dosing: the goal is anxiolysis, not sedation. THE INDICATION LIMIT, verbatim from the label's PRECAUTIONS: 'SILEO has not been evaluated for aversion behaviors to thunderstorms.' The pivotal trial and the label's effectiveness study were both New Year's Eve firework studies. There is therefore NO FDA-approved product for thunderstorm phobia; the only two randomised storm trials on this page are for imepitoin, which is EU-authorised and has no FDA-approved canine product, so storm phobia in the US is managed off-label and should be discussed as such. Label restrictions that must travel with the dose: do not use in severe cardiovascular, respiratory, liver or kidney disease, in shock, severe debilitation, or stress from extreme heat, cold or fatigue; do not use with pre-existing hypotension, hypoxia or bradycardia; do not use in a dog still sedated from a previous dose; not evaluated in dogs under 16 weeks of age or in dogs with dental or gingival disease, which can affect absorption; and administration to pregnant dogs may induce uterine contractions and/or decrease fetal blood pressure. Human handling is a real hazard - see the safety section before dispensing.

   Named products: Dexmedetomidine oromucosal gel - SILEO (Zoetis), NADA 141-456, US FDA-approved; verified from the FDA-published label via DailyMed. Indication verbatim: 'SILEO is indicated for the treatment of noise aversion in dogs.' Precaution verbatim: 'SILEO has not been evaluated for aversion behaviors to thunderstorms.'

   Randomised, double-blind, placebo-controlled clinical field study in 182 client-owned dogs with a history of firework-associated fear, treated on New Year's Eve up to five times. Overall treatment effect P<0.0001; excellent or good effect in 64/89 (72%) of dexmedetomidine dogs versus 34/93 (37%) of placebo dogs, with significantly fewer signs of fear and anxiety (P<0.0314) and no local tolerance or clinical safety concerns. Note that the 37% placebo response is itself a useful number for owner expectation-setting. Approved by the US FDA as SILEO, NADA 141-456 (Zoetis), indicated for the treatment of noise aversion in dogs. The evidence base is fireworks; thunderstorms were not studied and the label says so.

   Korpivaara M, Laapas K, Huhtinen M, Schoning B, Overall K. Dexmedetomidine oromucosal gel for noise-associated acute anxiety and fear in dogs - a randomised, double-blind, placebo-controlled clinical study. Vet Rec. 2017;180(14):356. PMID 28213531; DOI 10.1136/vr.104045

5. Separation anxiety: fluoxetine (Reconcile) 1-2 mg/kg PO once daily with a behaviour plan

   Approved / guideline-backed

   US FDA-approved for canine separation anxiety in conjunction with a behaviour modification plan. Dose 1-2 mg/kg PO once daily. Label eligibility limits: dogs must weigh at least 8.8 lb (4.0 kg) and be at least 6 months of age; effects in breeding, pregnant or lactating dogs have not been studied. Give a full 8-week trial before judging - the label instructs that if no improvement is seen within 8 weeks the veterinarian should discuss additional treatment plans - but also note that effectiveness and safety beyond 8 weeks have not been evaluated, so continuing past that point is a deliberate extralabel decision with a monitoring plan, not a default renewal. Not recommended for aggression, and not clinically tested for other behavioural disorders. Dose reduction for adverse effects preserved effectiveness in a majority of affected dogs. CONTRAINDICATED in dogs with epilepsy or a history of seizures, and seizures can occur in treated dogs with no seizure history - see the safety section, and tell the owner before the first tablet.

   Named products: Fluoxetine hydrochloride chewable tablets - Reconcile (Pegasus Laboratories), NADA 141-272, US FDA-approved; verified from the FDA-published label via DailyMed. Indication verbatim: 'For the treatment of canine SEPARATION ANXIETY in conjunction with a behavior modification plan.'

   Randomised, double-blind, multicentre field studies in the US and Canada demonstrating clinical efficacy and safety of Reconcile (fluoxetine 1-2 mg/kg/day) in conjunction with behaviour management for canine separation anxiety; 427 dogs across the two North American field studies contributed the label's safety data. The label's own effectiveness figures are the honest expectation-setting numbers for this whole page: at 8 weeks, 73% of dogs receiving Reconcile plus behaviour modification showed significant improvement versus 51% of dogs receiving behaviour modification alone. Approved by the US FDA as NADA 141-272 (Pegasus Laboratories).

   Simpson BS, Landsberg GM, Reisner IR, Ciribassi JJ, Horwitz D, Houpt KA, et al. Effects of Reconcile (fluoxetine) chewable tablets plus behavior management for canine separation anxiety. Vet Ther. 2007;8(1):18-31. PMID 17447222

6. Separation anxiety alternative: clomipramine (Clomicalm) 2-4 mg/kg/day - the label dose, not a low dose

   Approved / guideline-backed

   US FDA-approved as part of a comprehensive behavioural management programme for separation anxiety in dogs greater than 6 months of age. THE LABEL DOSE: 'The recommended daily dose of CLOMICALM tablets is 2 to 4 mg/kg/day (0.9-1.8 mg/lb/day). It can be administered as a single daily dose or divided twice daily based on patient response and/or tolerance of the side effects' (NADA 141-120). The dose matters and the label's own pivotal trial tells you why: the standard-dose arm worked, the low-dose arm did not. Set owner expectations honestly - vocalisation was the one sign that did not improve significantly versus placebo. Effectiveness and clinical safety for long-term use beyond 12 weeks have not been evaluated. The label advises periodic reassessment of haematological and serum biochemical data during administration - book those bloods, do not just run a baseline. Contraindicated in dogs with a history of seizures, with seizure-threshold-lowering drugs, in tricyclic hypersensitivity, with an MAOI (selegiline, amitraz) within 14 days either side, and in male breeding dogs. Not recommended for other behaviour problems such as aggression.

   Named products: Clomipramine hydrochloride tablets - CLOMICALM (Virbac AH), NADA 141-120, US FDA-approved; verified from the FDA-published label via DailyMed. Indication verbatim: 'CLOMICALM tablets are to be used as part of a comprehensive behavioral management program to treat separation anxiety in dogs greater than 6 months of age.'

   Prospective, randomised, double-blind, placebo-controlled, parallel-group international multicentre trial, 95 dogs, 2-3 months of treatment, behaviour therapy given to all arms. Standard-dose clomipramine (1 to <2 mg/kg PO q12h - arithmetically inside the label's 2-4 mg/kg/day) dogs were rated improved at least three times faster than placebo for destruction, defecation and urination, with more dogs improved at most time points and in owner global assessment (P<0.05 at certain time points). No significant difference from placebo for vocalisation at any time point. The low-dose arm (0.5 to <1 mg/kg q12h) produced no statistically significant effect. Mild transient vomiting in a small number of dogs. At 25 times the dose, convulsions and death occurred in 5 of 8 dogs, and testicular hypoplasia occurred at 12.5 times the maximum daily dose for 1 year. Approved by the US FDA as NADA 141-120 (Virbac AH).

   King JN, Simpson BS, Overall KL, Appleby D, Pageat P, Ross C, et al. Treatment of separation anxiety in dogs with clomipramine: results from a prospective, randomized, double-blind, placebo-controlled, parallel-group, multicenter clinical trial. Appl Anim Behav Sci. 2000;67(4):255-275. PMID 10760607; DOI 10.1016/s0168-1591(99)00127-6

7. Noise and storm anxiety where available: imepitoin (Pexion) - two RCTs, EU-authorised (EMA) only, no FDA-approved canine product

   Controlled trial in this species

   Imepitoin 30 mg/kg PO q12h has two randomised placebo-controlled canine trials behind it, and the two studied regimens are SHORT and specific: for fireworks, start 2 days before the anticipated event and give for 3 consecutive days; for storms, 28 days of continuous twice-daily dosing. Anything longer than that - 'continuously through a storm season', meaning months - is UNSTUDIED at both efficacy and safety, and matters because adverse events occurred in 24 of 30 imepitoin dogs over just the 28-day study, ataxia most frequently. There is no label duration to fall back on either: Pexion is an EU veterinary medicine authorised by the EMA under EMEA/V/C/002543, where the EMA lists its pharmacotherapeutic classification as 'Other antiepileptics; Antiepileptics' - it is fundamentally an antiepileptic product, and the exact authorised indication wording for any noise indication could not be verified from EMA in this research pass (the EPAR product-information PDF now redirects to the EU Veterinary Medicines Information site). So cite the two trials, not a label claim, and do not describe imepitoin as 'approved for noise aversion' anywhere. No FDA-approved finished imepitoin product for dogs was located, so this is not a US on-label option and US use would be extralabel prescribing of a product that may not be commercially available. Ataxia is the expected trade-off and it is common, not rare.

   Named products: Imepitoin - Pexion, EU marketing authorisation EMEA/V/C/002543, authorised by the EMA (verified on the EMA veterinary EPAR page, which lists the pharmacotherapeutic group as 'Other antiepileptics; Antiepileptics'). NOT FDA-approved: no US NADA/ANADA finished imepitoin product for dogs was located.

   Two randomised placebo-controlled trials, both in dogs. (1) Fireworks: placebo-controlled, randomised, double-blind, 238 client-owned dogs with noise phobia in Germany and the Netherlands; owners began imepitoin 30 mg/kg q12h or placebo 2 days before New Year's Eve and continued for 3 consecutive days. Fear and anxiety signs on a 16-item owner report were reduced by 6.1 scoring points versus placebo (P<0.0001), with a good or excellent overall effect odds ratio of 4.689 (95% CI 2.79-7.89, P<0.0001). (2) Storms: double-blind, placebo-controlled, randomised, 45 dogs (30 imepitoin at 30 mg/kg BID, 15 placebo) over 28 days; imepitoin was superior in storm logs and weekly surveys at weeks 2 and 4 and at end of study. Mild/moderate adverse events were reported in 26 patients - 24 imepitoin, 2 placebo - ataxia most frequent. Both trials were sponsored by or co-authored with Boehringer Ingelheim, the product's marketing authorisation holder. Neither trial ran longer than 28 days.

   Engel O, Muller HW, Klee R, Francke B, Mills DS. Effectiveness of imepitoin for the control of anxiety and fear associated with noise phobia in dogs. J Vet Intern Med. 2019;33(6):2675-2684. PMID 31568622; DOI 10.1111/jvim.15608 | Perdew I, Emke C, Johnson B, Dixit V, Song Y, Griffith EH, Watson P, Gruen ME. Evaluation of Pexion (imepitoin) for treatment of storm anxiety in dogs: A randomised, double-blind, placebo-controlled trial. Vet Rec. 2021;188(9):e18. PMID 33960445; DOI 10.1002/vetr.18

8. Prevention in puppies and non-fearful adults: teach a positive association with noise before there is a problem

   Early evidence

   Pair recorded or incidental noise with food and play from puppyhood, at a volume the dog does not react to, and continue through the first year. It is cheap, involves no drug exposure, and targets the window in which the problem actually forms, so it belongs in every puppy consultation. It is NOT free of failure modes, and the threshold rule is the reason: exposure ABOVE the dog's reaction threshold can sensitise rather than habituate, making the fear worse rather than preventing it. So the instruction is specific - start below the volume that produces any reaction, watch the dog rather than the volume dial, and stop and reduce if he orients, freezes, stops eating or leaves. A protocol that depends on a threshold has an adverse-effect profile by definition. Grade the evidence honestly to owners: this is survey-level and associational, not trial-proven.

   Cross-sectional online survey of 1,225 dogs: 52% were at least partially affected by firework fears, and the majority developed the fear in the first year of life, with new onsets declining to age seven and few beyond. The author's conclusion, verbatim from the abstract, is that 'the data indicate that training puppies or non-fearful adults to associate the noise with positive stimuli is highly effective in preventing later development of firework fears' - but the design is a one-time owner survey with retrospective recall of training efforts, which cannot establish prevention causally: owners of never-fearful dogs may simply recall having done more, and confident dogs are easier to expose in the first place. Treat the prevention effect as a strong association. Recovery data from the same cohort are useful for owner counselling: almost three-quarters of fearful dogs had recovered by the next morning, 10% took up to a day, 12% up to a week, and more than 3% took weeks or months. The same paper reports that both improvement AND deterioration of firework fears were frequently reported, so do not promise owners a one-way road in either direction.

   Riemer S. Not a one-way road - Severity, progression and prevention of firework fears in dogs. PLoS One. 2019;14(9):e0218150. PMID 31490926; DOI 10.1371/journal.pone.0218150

9. Environmental management and escape-proofing before the event - the highest-yield thing an owner can do in a week

   Laboratory evidence only

   Do this before the next firework night, not after. Confirm the microchip is registered with a phone number that actually works and add a collar tag. Secure doors, windows, fences and gates, and walk the garden looking for the gap a panicking dog would find. Take a leashed toilet break before dark, and keep him on lead outdoors for the whole event period even in a fenced garden. Close curtains, leave a light on, and mask noise with ordinary household sound. Offer a safe space the dog CHOSE himself - the bathroom, behind the sofa, a crate with the door fixed open - and never shut him in: do not crate or confine a panicking dog, because that is how dogs break teeth and nails and how the crate injuries in the red flags happen. Watch the temperature, because a dog panicking in a hot car, a sunlit room or a closed crate can overheat. Finally, secure the household's own medicines, chocolate, vapes and xylitol-sweetened products in a closed cupboard for the night; frightened dogs raid, and the ingestion follows the panic.

   Consensus harm-prevention practice rather than trial evidence, and graded accordingly - no randomised trial has tested escape-proofing or identification against a control. The justification is the mechanism and the frequency: firework fear is the commonest presentation of this condition (26% of 13,715 dogs feared fireworks, Salonen 2020 PMID 32139728), escape and self-injury are documented outcomes of it, and the self-injury pathway is already listed as a same-day red flag on this page. Riemer 2019 (PMID 31490926) also shows that a dog's recovery can take up to a week or longer in a minority, so the exposure is not confined to the night itself. Because the harm is severe, the intervention is free and the alternative is a lost or injured dog, this is recommended despite the evidence grade.

   Salonen M, Sulkama S, Mikkola S, Puurunen J, Hakanen E, Tiira K, Araujo C, Lohi H. Prevalence, comorbidity, and breed differences in canine anxiety in 13,700 Finnish pet dogs. Sci Rep. 2020;10(1):2962. PMID 32139728; DOI 10.1038/s41598-020-59837-z

10. Trazodone: widely used, thinly evidenced - prescribe with that stated out loud

    Early evidence

    Trazodone is by far the most-prescribed psychoactive drug in canine primary care, but the canine evidence base is one small open-label study for a narrow indication (tolerating post-surgical confinement), not a controlled anxiety trial. No FDA-approved veterinary trazodone product was located, so US canine use is extralabel and requires the prescriber's own AMDUCA judgement. It is reasonable as situational or adjunct therapy; it is not interchangeable with the approved products above, and it should not be the whole plan. If it is stacked on fluoxetine or clomipramine, that is a serotonergic combination - see the serotonin toxicity entry in the safety section and write the monitoring plan down.

    Named products: Trazodone hydrochloride - human-approved product used extralabel in dogs in the US. A DailyMed query returned 163 trazodone labels, none for a veterinary/canine product.

    Prospective open-label clinical trial, 36 client-owned dogs after orthopaedic surgery, trazodone approximately 3.5 mg/kg PO q12h escalating to approximately 7 mg/kg q12h (up to 7-10 mg/kg q8h if needed) for at least 4 weeks. 32/36 (89%) of owners reported moderate or extreme improvement in confinement tolerance and calmness; well tolerated alongside NSAIDs and antimicrobials; no withdrawals for adverse reactions; owner-reported median onset 31-45 minutes, median duration 4 hours or more. Open-label, no placebo arm, single indication - note also that the first 3 days co-administered tramadol, itself serotonergic. Context on use versus evidence: trazodone was prescribed to 1.33% of 32,468,046 canine primary-care records overall and to 8.4% of dogs carrying a behaviour-problem label, versus 0.02-0.03% for fluoxetine and clomipramine (Weng et al. JAVMA 2025, PMID 40107234).

    Gruen ME, Roe SC, Griffith E, Hamilton A, Sherman BL. Use of trazodone to facilitate postsurgical confinement in dogs. J Am Vet Med Assoc. 2014;245(3):296-301. PMID 25029308; DOI 10.2460/javma.245.3.296

11. Refer to a board-certified veterinary behaviourist for aggression, self-injury, or non-response at 8 weeks

    Approved / guideline-backed

    Refer when there is any bite or bite threat, self-injury, multi-trigger or generalised anxiety, a household safety concern, or no meaningful change after a full 8-week trial of an appropriate approved drug plus a real behaviour plan. Board certification is DACVB (American College of Veterinary Behaviorists) or ECAWBM (European College of Animal Welfare and Behavioural Medicine).

    Label-driven rather than trial-driven, and that is the point: both approved separation-anxiety drugs explicitly exclude aggression (Clomicalm NADA 141-120 'not recommended for other behavior problems, such as aggression'; Reconcile NADA 141-272 'not recommended for the treatment of aggression'), and the Reconcile label sets 8 weeks as the decision point for changing the plan while also not having evaluated effectiveness beyond it. AAHA 2015 positions behavioural management as a core competency with escalation to specialists.

    Hammerle M, Horst C, Levine E, Overall K, Radosta L, Rafter-Ritchie M, Yin S. 2015 AAHA Canine and Feline Behavior Management Guidelines. J Am Anim Hosp Assoc. 2015;51(4):205-21. PMID 26191821; DOI 10.5326/JAAHA-MS-6527

12. Dog-appeasing pheromone: do not build a plan on it

    Laboratory evidence only

    Owners will ask about diffusers, collars and sprays. They are low-risk and inexpensive, so there is no strong reason to forbid them, but there is no basis for selling them as treatment and none for letting them delay the steps above.

    Systematic review of prospective studies published January 1998 to December 2008, 7 canine and 7 feline reports. Only 1 study yielded sufficient evidence that dog-appeasing pheromone reduces fear or anxiety in dogs during training. Six canine studies yielded insufficient evidence, including both reports on noise phobia specifically, plus travel-related problems, fear/anxiety in the veterinary clinic, and stress and fear-related behaviour in shelter dogs. Overall 11 of 14 reports provided insufficient evidence and 1 provided lack of support.

    Frank D, Beauchamp G, Palestrini C. Systematic review of the use of pheromones for treatment of undesirable behavior in cats and dogs. J Am Vet Med Assoc. 2010;236(12):1308-16. PMID 20550445; DOI 10.2460/javma.236.12.1308

How it is diagnosed

• Take a full history plus video. Owner-recorded phone video of the dog alone, or during a storm or firework event, is one of the highest-yield additions to the history in this condition - Riemer's group used owner video to code firework fear objectively and found a backwards-directed ear position, measured at the base of the ear, to be the strongest single marker (Cohen's d = 0.69), ahead of locomotion (d = 0.54) and panting (d = 0.45) (Gahwiler S et al. Sci Rep 2020;10:16035. PMID 32994423). Two limits to carry: that study ranked behavioural markers against the same dogs on a control evening, it did NOT compare video against history, physical examination or a validated scale, so video is an addition and not a replacement for any of them; and the authors caution explicitly that 'individual differences must be taken into account when aiming to assess an individual's level of fear, as relevant measures may not be the same for all individuals' - vocalising and hiding did not survive correction because many dogs never did them at all.
• Define the trigger class precisely, because treatment differs: event-driven noise aversion (fireworks, thunder, gunshots), separation-related behaviour, social fear (strangers, other dogs), veterinary/handling fear, confinement intolerance, or generalised anxiety. Firework fear correlates strongly with gunshot and thunder fear and only weakly with other noises, and not with other behaviour problems (Riemer 2019, PMID 31490926). Note the regulatory consequence of splitting fireworks from storms: the FDA-approved noise-aversion product has not been evaluated for thunderstorms, so a storm-phobic dog is not covered by it.
• Perform a full physical, orthopaedic and neurologic examination and screen explicitly for pain. Around a third of referred canine behaviour caseloads involve a painful condition and in one contributing caseload the figure approached 80%; the authors recommend erring on the side of a trial of analgesia when pain is suspected even without an identified lesion (Mills DS et al. Animals 2020;10(2):318. PMID 32085528). When you choose that analgesic, choose it on the record and choose it for a dog - the commonest owner-side harm in this whole condition is a human NSAID or acetaminophen given at home in good faith.
• RECONCILE THE MEDICATION LIST BEFORE YOU PRESCRIBE, and ask about things owners do not think of as drugs. Both fluoxetine and clomipramine are contraindicated with a monoamine oxidase inhibitor, or within 14 days either side of one, and both labels name selegiline hydrochloride (L-deprenyl) AND amitraz. Two collisions are live on this very page: selegiline (Anipryl) is the approved canine drug for the cognitive dysfunction you are told to screen for in the next step, so a dog who screens positive at 9 years old and is started on selegiline must not then be started on fluoxetine; and amitraz is an acaricide in some tick collars and dips, so ask what is physically on the dog's neck. Also capture trazodone, tramadol, gabapentin, any other serotonergic drug, and any human medicine the household has been giving.
• Run a minimum database appropriate to age and health status before prescribing. The Reconcile (fluoxetine) label requires a comprehensive physical examination to rule out causes of inappropriate behaviour unrelated to separation anxiety, including a thorough history, assessment of the household environment and standard practice laboratory tests (NADA 141-272). The Clomicalm label additionally advises periodic reassessment of haematological and serum biochemical data DURING administration, not only before it (NADA 141-120), so book the follow-up bloods when you write the first prescription.
• In dogs 8 years and older, screen for canine cognitive dysfunction as a differential or comorbidity - not as an afterthought. Estimated prevalence in dogs of mean age 11.67 years was 14.2% versus only 1.9% diagnosed by a veterinarian, a 7.5-fold diagnosis gap (Salvin HE et al. Vet J. 2010;184(3):277-81. PMID 20005753). If you treat it with selegiline, see the interaction step above before adding any serotonergic drug.
• Score a validated baseline before you treat anything, so that response is measurable rather than remembered. Use the Lincoln Canine Anxiety Scale (LCAS) for event-driven anxiety and fear - 16 items, Cronbach's alpha 0.88, unidimensional on PCA, reducible to 11 items (Mills DS, Mueller HW, McPeake K, Engel O. Front Vet Sci. 2020;7:171. PMID 32318590; DOI 10.3389/fvets.2020.00171). Declare the conflict when you rely on it: the LCAS was validated on data from 226 dogs in an imepitoin trial, two of its four authors were employees of Boehringer Ingelheim (the imepitoin sponsor), and its treatment sensitivity was characterised against imepitoin - the same drug this page lists as a tier-2 option. Pair it with C-BARQ for the broader behavioural profile (Hsu Y, Serpell JA. JAVMA. 2003;223(9):1293-300. PMID 14621216; DOI 10.2460/javma.2003.223.1293).
• Separate separation-related behaviour from its mimics: incomplete house-training, inadequate exercise or enrichment, cognitive dysfunction, polyuria from a medical cause, and thunderstorm timing that happens to coincide with the owner's absence. The Clomicalm label defines separation anxiety by signs occurring in the owner's absence - vocalisation, destructive behaviour, excessive salivation and inappropriate elimination (NADA 141-120).
• Assess bite risk and household composition explicitly - children, elderly or immunocompromised household members, other pets - and document a management plan that prevents rehearsal of the problem while treatment takes effect. If SILEO is prescribed, this assessment must include who will handle the syringe: it is an alpha-2 agonist gel that must be given by an adult in gloves, and it will be stored in that household.
• Before the next firework season, audit containment and identification as a clinical task, not owner small-talk: current microchip registration with a correct phone number, a collar tag, secured doors, windows, fences and gates, and a leashed toilet break before dark. Escape during panic is the commonest route from this condition to a dead dog, and it is almost entirely preventable in advance.