Re:EMDR & Medications

Anne Marie,

As you note in your question, the issues are complex and answers specific to your situation could only be made after a more thourough clinical evaluation.

Some general thoughts. The general guidelines are that if a patient is on medications and also participates in EMDR, after the EMDR + medication work is done, the person is tapered off the medication (under medical supervision of course) and the EMDR work is checked and any remaining distress is worked on again.

My experience is that medications (1) may be clinically helpful in dealing with depression, and probably also (2) reduce EMDR (and probably all psychotherapy) effectiveness a bit. The size of the effect has to do with the patients reaction(s) to the medications and the particular medications being used. Like with EMDR, the goal would be to use medications to stabalize the patient and then work on issues, move off the medicaiton and work on what is left.

I do not know specific research on EMDR and medications, but the general idea that at least some of the distress associated with the original targets might return when medications are stopped and then would need to be reworked again is what is taught in EMDR training and matches my experience.

The general research on psychotherapy (in general, not EMDR specific) and medications for depression is, I think mixed. There are studies that suggest that the combination of anti depressant medications plus psychotherapy is more effective than either medication or psychotherapy alone. Other studies would seem to suggest that medication alone is as effective as the combination and I think that there is are recent studies that show that psychotherapy alone is equal or better than medications for depression. Van der Kolk has a study looking at EMDR vs Prozac under way, but I am not aware of final data from that study yet.

Bottom line of all of this is, at least in my experience and opinion, try psychotherapy alone without medications unless the depression is so overwhelming that medications are really necessary for day to day living and to have the energy to do the psychotherapy work. Another variable would be the side effects of the medications. The more problematic the side effects the more I would try psychotherapy alone first.

Again, note that others would disagree with this approach (I know many very good psychiatrists and psychologists who would start anti depresants first in almost all cases) so do explore the issues for yourself and talk with your therapist. Also, nothing in this post is made specific to your clinical case as I do not have sufficient data to make a case specific recommendation and would make the same general recommendation to anyone asking the question about combining psychotherapy and medications. Please talk with your therapist in detail about this issue. Also, it might be a good idea to talk with a psychiatrist rather than your general medical practicioner about the issue of medications.

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Re:EMDR & Medications, by Anne-Marie, 12/15/00

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