EMDR + Medication for PTSD: A Complete Guide to Combined Treatment
The key question: Do you need both therapy and medication for PTSD? The answer depends on your symptoms, but research shows combining EMDR therapy with the right medication can be more effective than either treatment alone.
Who This Applies To
We see this combination work well for:
- Veterans with nightmares and flashbacks
- Parents traumatized by difficult births
- Teens recovering from assault
- Anyone whose trauma symptoms are too intense for therapy alone
Understanding Your Treatment Options
How Each Treatment Works
| Treatment | What It Targets | How Long It Takes | Strengths | Limitations |
| EMDR Therapy | Processes traumatic memories so they stop triggering you | 6-12 sessions for most people | Large, lasting improvements; addresses root cause | Can initially increase distress; requires focus |
| Medication (SSRIs) | Calms the brain’s alarm system; improves sleep | 3-6 weeks for full effect | Quick relief for severe symptoms | Smaller improvements; benefits fade when stopped |
What Research Shows About Combined Treatment
| Outcome | EMDR Alone | Medication Alone | EMDR + Medication |
| PTSD symptom reduction | Excellent (large improvements) | Moderate (some improvement) | Excellent (similar to EMDR alone) |
| Long-term recovery | 50-70% stay recovered after 6+ months | Benefits often fade when medication stops | Same as EMDR alone; better than medication alone |
| Depression relief | Strong when trauma causes depression | Moderate | Best for complex cases with mood disorders |
| Side effects/dropout | 10-17% stop treatment | 8-15% stop due to side effects | Similar to single treatments |
Key insight: Adding medication to EMDR doesn’t always improve the final outcome, but it can make the therapy process more manageable.
When You Might Need Both Treatments
Consider medication + EMDR if you have:
- Severe insomnia (sleeping less than 6 hours)
- Panic attacks or extreme anxiety
- Depression alongside PTSD
- Symptoms so intense you can’t focus in therapy
- Bipolar disorder with trauma
EMDR alone might be enough if:
- You can sleep reasonably well
- Your symptoms don’t prevent daily functioning
- You can concentrate for 60-90 minutes
- You prefer to avoid medication
The Treatment Timeline: What to Expect
Weeks 1-4: Stabilization Phase
- Medication: Start SSRI (like sertraline or paroxetine) at low dose
- Goal: Reduce panic, improve sleep to 6+ hours nightly
- EMDR: History-taking and preparation skills only
Weeks 5-8: Beginning EMDR Processing
- Medication: May increase dose if needed
- EMDR: Start processing traumatic memories
- Monitoring: Track symptoms weekly; adjust medication as needed
Weeks 9-16: Active Treatment Phase
- EMDR: Continue memory processing sessions
- Medication: Fine-tune dosing; add sleep aids if nightmares persist
- Goal: Reduce flashbacks to less than once weekly
Months 4-6: Maintenance and Tapering
- EMDR: Complete remaining sessions; focus on future triggers
- Medication: Begin gradual reduction (25% every 4 weeks)
- Goal: Maintain gains with minimal or no medication
Important Safety Considerations
Medications That Can Interfere with EMDR
- High-dose anxiety medications (benzodiazepines): Can numb emotions needed for processing
- Anticholinergic drugs: May reduce memory formation during therapy
- Solution: Use these sparingly and coordinate with your EMDR therapist
Special Considerations for Bipolar Disorder
- Risk: EMDR can trigger mood episodes if sleep is disrupted
- Protection: Keep mood stabilizers (lithium, lamotrigine) throughout treatment
- Benefit: EMDR reduces depressive episodes when properly managed
What You Should Know
Studies show EMDR outperformed medication alone in head-to-head trials, with fewer side effects and longer-lasting benefits. This information helps you make informed decisions about your care.
Red Flags: When to Adjust Treatment
Call your doctor if you experience:
- Increased suicidal thoughts
- New manic symptoms (racing thoughts, no sleep, impulsive behavior)
- Severe dissociation during or after EMDR sessions
- Worsening nightmares or flashbacks after starting medication
Future Treatments on the Horizon
MDMA-Assisted Therapy: Currently in FDA trials, showing promising results when combined with therapy, though protocols differ from standard EMDR.
Memory Reconsolidation Blockers: Medications like propranolol are being studied to enhance memory processing, with mixed results so far.
Our Integrated Approach at Mind Body Seven
Step 1: Comprehensive Assessment
- Detailed trauma history
- Current symptoms and their severity
- Past medication responses
- Treatment preferences
Step 2: Personalized Treatment Plan
- Medication optimization if needed
- EMDR preparation and readiness assessment
- Clear timeline and expectations
Step 3: Coordinated Care
- Psychiatrist and EMDR therapist communicate every 4 weeks
- Regular symptom monitoring
- Flexible adjustments based on your progress
Step 4: Transition to Independence
- Gradual reduction of medication when appropriate
- Completion of EMDR processing
- Relapse prevention planning
What Patients Tell Us
“The medication lowered the volume on my anxiety so I could actually engage in EMDR. Together, they helped me reclaim my sleep, my relationships, and my hope for the future.”
The combination approach works because medication creates the stability needed for trauma processing, while EMDR addresses the root cause for lasting change.
Remember: PTSD is treatable. Whether you need therapy alone or therapy plus medication, recovery is possible with the right approach for your unique situation.
This information is based on current research and clinical guidelines. Individual results may vary. Always work with qualified professionals for PTSD treatment.
References
Bajor, L. A., Balsara, C., & Osser, D. N. (2022). An evidence-based approach to psychopharmacology for posttraumatic stress disorder – 2022 update. Psychiatry Research, 317, 114840. https://doi.org/10.1016/j.psychres.2022.114840
Merz, J., Schwarzer, G., & Gerger, H. (2019). Comparative efficacy and acceptability of pharmacological, psychotherapeutic, and combination treatments in adults with post-traumatic stress disorder: A network meta-analysis. JAMA Psychiatry, 76(9), 904-913. https://doi.org/10.1001/jamapsychiatry.2019.0951
Pagani, M., Di Lorenzo, G., Verardo, A. R., et al. (2012). Neurobiological correlates of EMDR monitoring—An EEG study. PLoS ONE, 7(9), e45753. https://doi.org/10.1371/journal.pone.0045753
Rothbaum, B. O., & Watkins, L. E. (2025). An update on psychotherapy for the treatment of PTSD. American Journal of Psychiatry, 182(5), 424-437. https://doi.org/10.1176/appi.ajp.20250110
Shapiro, F. (2014). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (2nd ed.). Guilford Press.
Steenkamp, M. M., Litz, B. T., Hoge, C. W., & Marmar, C. R. (2015). Psychotherapy for military-related PTSD: A review of randomized clinical trials. JAMA, 314(5), 489-500. https://doi.org/10.1001/jama.2015.8370
van der Kolk, B. A., Spinazzola, J., Blaustein, M. E., et al. (2007). A randomized clinical trial of EMDR, fluoxetine, and placebo in PTSD: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68(1), 37-46. https://doi.org/10.4088/JCP.v68n0105
Williams, T., Phillips, N. J., Stein, D. J., & Ipser, J. C. (2022). Pharmacotherapy for post-traumatic stress disorder. Cochrane Database of Systematic Reviews, 3, CD002795. https://doi.org/10.1002/14651858.CD002795.pub3
Wright, S. L., Karyotaki, E., Cuijpers, P., et al. (2024). EMDR versus other psychological therapies for PTSD: An individual participant data meta-analysis. Psychological Medicine, 54(8), 1580-1588. https://doi.org/10.1017/S0033291723003446
Mitchell, J. M., Bogenschutz, M., Lilienstein, A., et al. (2021). MDMA-assisted therapy for severe PTSD: A randomized, placebo-controlled phase 3 study. Nature Medicine, 27(6), 1025-1033. https://doi.org/10.1038/s41591-021-01336-3
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