Navigating Medication and EMDR Therapy
Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy designed to alleviate the distress associated with traumatic memories. The therapy involves recalling distressing events while the therapist directs the client's eye movements or uses other forms of bilateral stimulation. For this process to be effective, clients need to be able to access the emotional content of their traumatic memories. This is where certain medications can present a significant challenge.
Benzodiazepines: The Primary Concern
Benzodiazepines are a class of psychoactive drugs often prescribed for anxiety, insomnia, and panic attacks. These include common medications like Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), and Valium (diazepam). Therapists widely discourage their use, particularly on an 'as-needed' basis, during the reprocessing phases of EMDR for several key reasons.
- Impaired Memory Consolidation: Benzodiazepines can interfere with memory formation and recall, which are critical for the reprocessing phase of EMDR. By affecting the brain's memory systems, these drugs can prevent the patient from fully accessing and re-integrating traumatic memories in a new way.
- Emotional Numbing: The anxiolytic (anxiety-reducing) effect of benzodiazepines can suppress the emotional intensity associated with trauma. EMDR relies on the client's ability to tolerate and process this emotional distress; if the emotion is blunted, the therapeutic process can be stalled or rendered ineffective.
- Reinforcement of Avoidance: Taking 'as-needed' benzodiazepines can create a safety behavior where the client learns to avoid emotional distress through medication. This can reinforce the very avoidance behaviors that EMDR is designed to overcome.
Other Medications with Potential Interference
While benzodiazepines are the most well-documented culprits, other medications can also influence the EMDR process. The key factor is how a drug affects emotional intensity and memory processing.
Opioids and Antipsychotics
Opioid-based painkillers (e.g., codeine, oxycodone) and antipsychotic medications can similarly reduce emotional intensity, potentially slowing down or hindering the reprocessing of traumatic memories in EMDR. For clients with more severe trauma or PTSD, a therapist might initially use medication to make a memory feel more manageable, with the goal of later processing the trauma without medication. Careful coordination between the prescribing doctor and the EMDR therapist is essential in these cases.
Sleep Aids and Other Sedatives
Medications prescribed for insomnia and other sedatives, such as Ambien (zolpidem) and Lunesta (eszopiclone), can also affect the EMDR process. The impact can vary depending on the specific medication and dosage, but as with other drugs that alter consciousness or mood, they should be used with caution during EMDR. Some sleep aids can interfere with the processing that occurs during sleep, an important component of the brain's natural healing process.
Beta-Blockers
Beta-blockers like propranolol are sometimes prescribed to manage physical symptoms of anxiety, such as a racing heart. These medications can dampen the physiological sensations associated with fear and anxiety. Since EMDR engages both the emotional and physical aspects of a traumatic memory, blunting the physical sensations might interfere with the complete reprocessing of the event.
Medications That Generally Don't Interfere
It is important to note that many medications do not interfere with EMDR and may even be necessary for a client to be stable enough to engage in the therapy.
Antidepressants (SSRIs)
Many antidepressants, including Selective Serotonin Reuptake Inhibitors (SSRIs) like Prozac (fluoxetine) and Zoloft (sertraline), are generally considered safe to continue during EMDR. While some people feel emotionally blunted by SSRIs, clinical experience suggests they don't reduce the long-term effectiveness of EMDR. In fact, antidepressants can be crucial for stabilizing a client's mood enough to participate safely in trauma therapy.
ADHD Medications
Stimulant medications for ADHD, such as Adderall and Ritalin, are often fine to continue during EMDR sessions. These medications can help with focus and clarity, which can sometimes be beneficial for a client during the reprocessing phase. However, for individuals with recent trauma, stimulants might, in some rare cases, facilitate the formation of more vivid fear-conditioned memories, so it's essential to discuss this with your therapist and prescribing physician.
Comparison of Medications and EMDR Interaction
| Medication Class | Example Medications | Impact on EMDR | Rationale | Discussion Points with Your Team |
|---|---|---|---|---|
| Benzodiazepines | Xanax, Klonopin, Valium | High Interference | Impairs memory formation; reduces emotional intensity | The impact of 'as-needed' doses before sessions and potential alternatives. |
| Opioids | Oxycodone, Codeine | Moderate Interference | Can reduce emotional intensity, slowing processing | Dosage and scheduling and the potential impact on your therapy. |
| Antipsychotics | Risperidone, Seroquel | Moderate Interference | Can reduce emotional intensity, affecting processing | Requires careful discussion with your providers regarding impact on EMDR. |
| Sleep Aids | Ambien, Lunesta | Variable Interference | Can affect memory consolidation and sleep-based processing | Potential impact of use near session times. |
| Beta-Blockers | Propranolol | Low to Moderate Interference | Dampens physical anxiety sensations, potentially limiting processing | How and when you take the medication and its potential effect. |
| SSRIs/Antidepressants | Zoloft, Prozac | Low Interference | Generally considered compatible; can provide necessary stability | Often continued as prescribed; their role in mood stabilization. |
| ADHD Stimulants | Adderall, Ritalin | Low Interference | Can improve focus; generally does not impede processing | Potential benefits and any concerns during reprocessing. |
The Importance of Collaboration
The most important takeaway is the need for open and honest communication with your entire medical and therapeutic team. Never stop taking a prescribed medication abruptly without consulting your doctor, as this can have serious health consequences and cause withdrawal symptoms. Your EMDR therapist and your prescribing physician should work together to ensure your medication plan supports, rather than hinders, your therapeutic progress.
Conclusion
For effective EMDR therapy, clients must be able to engage with and process traumatic memories both emotionally and physically. Certain medications, particularly benzodiazepines, opioids, and some sedatives, can significantly impede this process by blunting emotions and interfering with memory. However, other medications, such as SSRIs and ADHD stimulants, are often compatible with EMDR and may even be necessary for a successful therapeutic journey. The best approach is a collaborative one, involving careful communication with your EMDR therapist and prescribing doctor to create a treatment plan that maximizes both your safety and therapeutic potential. By understanding the interaction between pharmacology and EMDR, you can take a more active and informed role in your recovery process.
