EMDR (Eye Movement Desensitization and Reprocessing) therapy has become an increasingly popular and evidence-based treatment for post-traumatic stress disorder (PTSD).
However, some clients report increased depression in the days or weeks following EMDR sessions. It’s crucial we understand this phenomenon and properly support clients through it.
Why Does Depression Occur Post-EMDR?
There are a few hypothesized reasons why depression may emerge after an EMDR session:
EMDR allows suppressed emotions to surface. As clients process traumatic memories, they may start feeling emotions that were previously blocked for coping. This can be overwhelming at first.
Unresolved memories may initially worsen symptoms. While EMDR helps create long-term relief, in the short-term, working through traumatic memories can exacerbate negative thought patterns.
Neurological changes from EMDR may contribute. EMDR is believed to forge new neurological pathways and alter limbic system functioning. These brain changes may temporarily worsen mood.
The important thing is to anticipate and properly address this depression.
Risk Factors: Who’s More Vulnerable?
Certain clients seem more prone to post-EMDR drops in mood. Risk factors include:
Pre-existing mood disorders
Clients with diagnoses like major depressive disorder, bipolar disorder, or persistent depressive disorder tend to be more susceptible. EMDR may trigger downward spirals in their condition.
Isolated clients without close friends or family to talk to after EMDR seem impacted more heavily. Having emotional support through the process is key.
Childhood trauma
Those who endured chronic childhood abuse and neglect tend to struggle more with post-EMDR mood crashes. Their neural pathways are strongly engrained.
Table 1. Main Risk Factors for Post-EMDR Depression
| Risk Factor | Description |
|---|---|
| Pre-existing mood disorders | Depression or bipolar diagnoses |
| Lack of social support | No friends/family to talk to |
| Childhood trauma | Chronic early-life abuse/neglect |
Strategies Clinicians Can Use
As therapists, what steps can we take to help clients avoid steep drops in mood after EMDR?
Thorough assessment
Carefully screen clients beforehand for risk factors like mood disorders. Adjust the EMDR approach accordingly.
Prepare clients mentally
Forewarn clients that increased depression is possible so they aren’t blindsided by it. Set expectations.
Check-in frequently
Closely monitor clients in the days/weeks after. Ask about mood changes at each session.
Have coping plans ready
Equip clients with healthy coping strategies they can use if depression emerges post-EMDR.
Adjust EMDR intensity
With very high-risk clients, use a gentle EMDR approach. Target less intense memories first.
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When to Seek Extra Support
If clients experience severe, unremitting depression after EMDR that impairs functioning, extra help may be needed.
Options include:
Medications. A psychiatric evaluation for antidepressant medications may provide relief.
Intensive therapy. Extra therapy sessions to work through the depression can stabilize mood.
Inpatient care. If depression is profoundly impairing or clients have suicidal thoughts, inpatient hospitalization lets clients heal in a protected environment.
With proper precautions by clinicians, post-EMDR depression can usually be well-managed. But in more severe cases, extra treatment is key.
Bottom Line
While EMDR therapy often reduces traumatic stress over the long-term, temporary depression is a common side effect in the days or weeks afterwards for many clients.
By understanding risk factors, using preventative strategies, and seeking additional care when necessary, we can help clients successfully move through this phase to achieve EMDR’s full benefits. Consistent support as clinicians is critical.
I also found your article on ‘Depression after EMDR’ rather enlightening.
As an integrative counsellor, I trained in both EMDR and IEMT to help people navigate problematic symptoms of trauma related PTSD. Moreover, I’d noticed my own feelings of low mood after receiving eye movement therapy some years ago, and quite recently, a client had reported their own lingering feelings of depression after receiving treatment. I’ve consequently undertaken a little research, particularly on Edna Foa’s work with trauma, and learned how layers of trauma are laid down as ‘separate networks’ from the typical networks that are consciously available to us, and that the process of eye movement therapy can lift these traumas to reveal earlier traumas underneath. Such earlier traumas are often hidden from us, but subsequently activated through the eye movement process, which accounts for a client occasionally reporting consequent low mood sometime after treatment.
Thank you.
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