There is no contraindication to continuing one's medication while having EMDR therapy. It is suggested, however, that after the successful conclusion of EMDR therapy, one might visit his/her psychopharmacologist to see if the same medication and or dose is still appropriate or no longer needed due to the effectiveness of EMDR therapy.

Since anti-depressants treat mood disorders & EMDR is best used to treat trauma/PTSD, there are not any contraindicators for using both simultaneously: however, it is important that a qualified person prescribe/perform the treatments (i.e. a psychiatrist for the anti-depressant(s) & a certified EMDR therapist for the EMDR).  It is equally important that one continue with both throughout treatment/use.

Mrs C is mistaken in her belief that she must stop her medications to go into EMDR.  You are correct!  The risk to her is too great.  It has been shown in research that those w/a depressive disorder who go on and off their medications according to whether or not the person is experiencing an exacerbation of symptoms, causes lesions on the brain that will cause worsening symptoms & increased frequency of episodes.  If Mrs. C is on the waiting list for an EMDR therapist who has told her she cannot be on her medications, Mrs. C would benefit from contacting the therapist again to  clarify.  IF the therapist does require her to go off her anti-depressant, then I reccommend she seek out another EMDR provider.

Thanks both for your comments. Mrs. C. is on an anti-depressive for the sake of her intense anxiety. It seems to me that, if the anxiety is too intense, it might even interfere with the application of EMDR. The brief psychotic episode had been in terms of being flooded by stimuli, not in terms of hallucinations, voices and delusions.

It seems indeed to me that this therapist will not be a wise choice.

Dear Peter,

EMDR is based on eye movements when the trauma is recalled. It may take some sessions but then it is over. Antidepressants take two months to reach their full potential,  and your trauma may still lure there. Antidepressants are for depression and EMDR for (acute) traumas. However they are not incompatible in that sense that they could not be administered simultaneously.

Comorbidity for mood disorder is high in persons with PTSD: there is no reason to stop treatments for mood disorders, either pharmacological or psychosocial, when introducing EMDR to treat PTSD

PTSD is listed in the DSM as an anxiety disorder.  EMDR, according to research, is one of the more excellent therapies in terms of coping with anxiety.

Good luck w/Mrs. C!

Thanks David, also for the references. I think you are right in calling EMDR an exposure therapy. However, there is evidence that the eye-movements do contribute to a more rapid anxiety (or negative emotion) reduction; see the references below. The mechanism is not what Shapiro thought it to be (the left-right hemisphere nonsense). Van den Hout speculates that it may be a partial occupation (charging) of the working memory by the eye movements, keeping the emotions during exposure within the limits that are more optimal for extinction. (Behavior therapist in the 60-ies and 70-ies used relaxation to this end.) Besides, EMDR therapist have invented innovations in exposure.

 Hout, M.A. van den & Engelhard, I.M. (2012). How does EMDR work? Journal of Experimental  Psychopathology, 5, 724-738.

Hout, M.A. van den, Rijkeboer, M.M., Engelhard, I.M., Klugkist, I., Hornsveld, H., Toffolo, M.J.B., & Cath, D.C. (2012). Tones inferior to eye movements in the EMDR treatment of PTSD. Behaviour Research and Therapy, 50, 275-279.

Smeets, M.A.M., Dijs, M.W., Pervan, I., Engelhard, I.M., & Hout, M.A. van den (2012). Time-course of eye movement-related decrease in vividness and emotionality of unpleasant autobiographical memories. Memory, 20, 346-357.

If the findings would be reproducible and attention distribution is the mechanism behind a more rapid extinction, I wonder whether it will be doing better than classical systematic desensitization with relaxation as anxiety damper.

But now we are digressing. This issue deserves a separate discussion.

The initial question was whether EMDR is incompatible with an antidepressant. The clear-cut answer is no. Antidepressants can very well be combined with any of the evidence-based trauma-focused psychotherapies. Benzodiazepines are different because they impair the patient's cognitive functions and may therefore interfere with any sort of psychotherapy.

One should, where appropriate, use both medication and EMDR and other "evidence-based" treatments for PTSD

Article Pharmacotherapy of post-traumatic stress disorder

As a practical matter, many / most patients with PTSD, anxiety and/or depression are on SSRI's before they get to do psychotherapy. Do the EMDR, exposure or other effective psychotherapies and then adjust/withdraw the medications as needed. 

In my experience, EMDR is tolerated better than the usual exposure approaches, leading to better compliance. It may also add something that is yet to be defined.

There is, in my experience, no reason to stop medication for EMDR to be effective

Article Pharmacotherapy of post-traumatic stress disorder

Thank you.

From the research I've read over the past umpteen million years, I'd say it would be very difficult research to do effectively to prove either way. Sounds like the therapist has his own agenda.

Hi Peter,

I agree w/David Skaer, sounds like the therapist has his own agenda, & w/you--the high risk level--particularly since Mrs. C. seems fragile having already suffered one psychotic break, however short lived it might have been or low dosage of her medication.  Going off of her medication could very well put her back into another psychotic break.  Has she spoken with her psychiatrist about the therapist's demand she be off all medication(s) for EMDR to work?  If not, I suggest she do so.  

Are y'all in the US?  Why is Mrs. C. on a waiting list?  Does she have insurance?  If yes, the care management for that insurance should be able to recommend another EMDR therapist.  IF Mrs. C. is not in the US, but in a country that provides socialized medicine, she might be stuck w/this 1 therapist who, frankly rings warning bells for me when I read your details!

From those who know EMDR treatment best, medications can provide a stability that allows the EMDR to work.  Despite being on a minimal dose, she should not stop the medication until her psychiatrist has an opportunity to discuss her treatment options w/her & then only on that doctor's advice.  As for that minimal dose being negligible, it truly is a very individualized treatment plan that works best when it's individualized.  If that low dose manages her symptoms so that they do not interfere with her daily life, then that is a good thing.  Some people do not need a whole lot of a medication in order for it to suppress/treat symptoms while others need massive doses to get minimal relief.

I am interested in hearing how this whole situation works out, if you would not mind posting updates?  I hope she can find another EMDR-qualified therapist, one who recognizes that the medicine(s) and EMDR work together in support of one another to help the person gain a better state of well-being.