what pharmacological and non-pharmacological options are available for managing anxiety disorders in cats?

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Gabapentin is the first-line pharmacological anxiolytic for cats, recommended for administration ideally the evening before and at least 2 hours before presentation for anxious patients undergoing conscious oral examination or other stressful procedures. 1 For rapid-acting sedation in new or difficult-to-assess cats, butorphanol, acepromazine, dexmedetomidine, or alfaxalone are recommended. These agents are appropriate when a faster onset is required and a pre-visit oral protocol is not feasible. 1 Gabapentin is also used on an as-needed basis for fears, phobias, and panic, and can be incorporated into daily protocols for general fears and anxieties. Other drug classes used in cats for behavioral conditions include benzodiazepines (alprazolam, diazepam, midazolam, clonazepam), tricyclic antidepressants (amitriptyline, nortriptyline, clomipramine, imipramine, doxepin), selective serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram), dual serotonin-norepinephrine reuptake inhibitors (venlafaxine, duloxetine), and serotonin 2A antagonist/serotonin reuptake inhibitors (trazodone, nefazodone). 2 For medications requiring receptor-level changes to take effect, treatment response may not appear for 5–8 weeks. 2 When combining medications, dosages may change and interactions can occur. 2 Benzodiazepines carry a clinically important adverse effect profile that requires monitoring. Some cats become extraordinarily sedated and are at risk for self-trauma; others become extraordinarily aroused and are equally at risk for self-injury. Because individual response cannot be predicted in advance, monitoring should include heart rate, agitation or sedation level, profound changes in appetite, vomiting, non-transient diarrhea, and any new or changed problematic behaviors. 2 Non-pharmacological management is a required component of any anxiety treatment program, not an optional adjunct. Techniques include low-stress handling, use of