5 Mar 2025
Lauren Demos
Job Title
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Add to this that their rise in household popularity in recent years, overtaking canines in many reports, means that veterinarians are now exposed to cats on an ever-increasing frequency.
One branch of feline medicine in particular has been expanding almost as quickly as household pet cat numbers: feline behaviour. As we broaden our knowledge of the feline in this regard, first opinion clinicians are seeing increasing presentations for feline behavioural concerns, with one of the frequent complaints relating to cats experiencing stress.
Considering that clinical signs of stress and other behavioural issues in cats often overlap with many common feline medical conditions (for example, hyperthyroidism, urinary tract infections and allergic dermatitis), a stringent protocol is needed to provide clinicians a pathway to get the felines feeling fine again.
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Physical signs of stress in cats can include compulsive acts such as over-grooming, physiological changes such as mydriasis and other behavioural changes such as aggression or increased vocalisations, to name just a few. Cats can present for these directly, though some of these signs may be subtle.
Cats may also present for more generalised changes such as increased hiding frequency, episodes of inappropriate elimination, eating less or not acting like themselves. In short, no pathognomonic clinical signs for stress exist in cats.
Anticipated stressful events, such as veterinary or recreational travel, may also elicit pre-emptive veterinary visits from clients and their cats, as they seek ways to minimise anticipated travel stress.
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The management of feline behavioural issues, including stress, often begins best with a discussion designed to establish client expectations.
For acute events, positive outcomes are generally considered more achievable and may only warrant abbreviated discussions. For more chronic concerns, realistic goals should be established.
An initial client conversation, therefore, generally includes some or all of the following:
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Depending on the specific issue the veterinary surgeon is aiming to address, approaches to environmental modification are often a mainstay of treatment.
This is a diverse and wide-ranging topic in feline medicine that is constantly evolving, with many good articles and books now present on the subject. This area of feline behaviour is well beyond the scope of this article, but an initial review on the topic has been written by Ellis (2009).
Anxiolytic medications licensed specifically for veterinary patients are almost non-existent, with clomipramine being one of the few exceptions (in some countries) for use in felines (Denenberg and Dubé, 2018).
In lieu of specific feline pharmacotherapeutics, many human medications have been applied off licence to feline patients, with variable results.
One survey of Finnish vets found that common behaviour medications (for both cats and dogs) had included amantadine, benzodiazepines, buspirone, fluoxetine, gabapentin, monoamine oxidase inhibitors, mirtazapine and tricyclic antidepressants.
In addition, sedation and analgesic agents were also prescribed, including butorphanol and tramadol (Raekallio et al, 2024).
A full review of these drugs is beyond the scope of this article, but a more detailed review has been written by Denenberg and Dubé (2018).
Gabapentin has become a mainstay in feline medicine for off-licence use to decrease stress, and as an aid in various behavioural and medical concerns.
Dosed prior to desired effect, it is generally considered safe and effective. One study found that when given to cats 90 minutes prior to a veterinary visit, it produced significantly lower stress scores, and sedative effects resolved within eight hours of administration (Van Haaften et al, 2017).
It should be noted that dose adjustments are necessitated in cats with renal disease, as these patients have been shown to have significantly higher serum concentrations after dosing than healthy counterparts (Quimby et al, 2022).
Of further clinical interest, one study found that administration of gabapentin significantly decreased systolic blood pressure in both healthy cats and cats with renal disease by an average of 12mmHg, so this should be factored into any results obtained from patients receiving gabapentin prior to undergoing sphygmometry (Quimby et al, 2024). A recently licensed product in the UK and EU that is also available in North America is Bonqat, a liquid form of pregabalin. Bonqat is licensed to deal with short-term feline anxiety related to travel and vet visits.
While many clinicians are now familiar with the use of gabapentin, pregabalin given 90 minutes prior to a veterinary visit has been shown to reduce perceived stress in patients administered the medication (Lamminen et al, 2023).
Pregabalin is a structural analogue of the neurotransmitter gamma-aminobutyric acid. Compared to gabapentin, it is a more potent drug that provides similar efficacy at a smaller dose.
Feline facial pheromone analogues, often found in sprays and/or diffusers, have been readily available for many years. A detailed review has been written by Vitale (2018).
Although data is mixed as to their efficacy, due to their oft-perceived benefit, and the minimal risk presented to patients, their use has grown in veterinary practice (Crump, 2023). Other diffusers include calming essential oils available in various formulations, which may provide similarly questionable efficacy with little to no downsides.
Nutrition has also taken a role in combating stress within feline patients. This includes a veterinary prescription diet supplemented with L-tryptophan and alpha-casozepine, which has shown potential benefit in some situations as an aid for the reduction of anxiety (Landsberg et al, 2017).
As we grow to learn more about feline stress and other related conditions, we continue to expand the targeted approaches available with which to combat these issues. Other non-traditional therapies have included the use of acupuncture and other Eastern modalities, and even species specific music (Hampton et al, 2020).
Without doubt, these tools will continue to expand given time and the marked interest in keeping domestic cats at their healthiest (and happiest).
Domestic cats are a familiar and increasingly popular pet, and the extended contact they share in our lives means an increased perception and awareness of the physiological and behavioural issues they face.
As stress itself left untreated can lead to both behavioural and physical issues, it is imperative for a veterinary practitioner to have a toolkit with which to approach the issue.
This then formulates a methodical approach to identify the underlying issues, rule in or rule out comorbidities, and can be hugely helpful in achieving a successful outcome.
Use of some of the drugs in this article is under the veterinary medicine cascade.
Lauren Demos
Job Title