Treating Depression with EMDR

Depression causes immense suffering and is one of the main reasons people come to therapy. According to the CDC, the prevalence for depression is 18.5% of the US adult population. In addition, the National Institute of Mental Health estimates that 21 million adults (8.3% of the adult population) in the US have had at least one major depressive episode. It has the potential to severely interrupt a person’s quality of life from the associated distress and loss of functioning. In fact, the economic burden of major depression in 2018 was estimated to be along the lines of $326 billion.

Common Symptoms of Depression

Common symptoms of depression include low mood, feelings of sadness, loss of interest in pleasurable activities, crying spells, low energy, restlessness or agitation, changes in appetite, changes in sleep, feelings of hopelessness and helplessness, and suicidal ideations. Other symptoms can manifest as well across individuals of varying cultures and ages.

Treatments for Depression

First-line treatments for depression are medication and psychotherapy. Other treatments have been becoming more and more popular as well.

Medication: a wide variety of pharmacological options exist that include antidepressants of varying classes, mood stabilizers, and sometimes what are called atypical antipsychotic medications. Typically a client will consult with a psychiatrist (a physician) or a psychiatric nurse practitioner who all have specialized training and authority to prescribe these psychotropic drugs. It is also common for primary care doctors to prescribe these medications for their patients when the mental health presentation is relatively simple.

Psychotherapy: Cognitive-Behavior Therapy is the most common psychotherapy approach for treating depression and involves changing a client’s thoughts and behaviors to influence their overall mood and symptoms of depression. Eye Movement Desensitization and Reprocessing (EMDR) represents another effective approach that this blog is focused on. The next sections will be dedicated for discussing this!

Other treatments that are becoming popular: Recently there has been a surge of demand for alternate therapies for depression. One is Transcranial Magnetic Stimulation (TMS) which is approved by the FDA for treatment-resistant depression and which uses magnetic waves to stimulate areas of the brain. Ketamine is another treatment approved for treatment-resistant depression.

EMDR is a Powerful Psychotherapy

What is EMDR?

EMDR, which stands for Eye Movement Desensitization and Reprocessing Therapy, is a psychotherapy approach that enables people to heal and recover from disturbing life experiences. It has been practiced around the world for the past 30 years or so and is an accepted treatment for trauma and PTSD by the American Psychiatric Association, Veterans Administration, Department of Defense, World Health Organization, and the International Society for Traumatic Stress Studies, among others.

EMDR is based on the idea that current dysfunction stems from insufficiently-processed, maladaptively stored disturbing memories from the past. Essentially, when a person experiences a traumatic event or something that is beyond the capacity of their brain to process at the time, parts of the experience get stuck causing them to encounter problems down the road.

The therapist leads a client in a series of eye movements or other types of bilateral stimulation (such as tapping or bilateral sounds). At the same time, the client focuses on various aspects of a disturbing memory.  During this procedure, clients process the memory often in a positive and rapid way that leads to a peaceful resolution.

The Link Between Trauma and Depression

The last section introduced EMDR as a powerful psychotherapy for trauma – but what does that have to do with depression? After all, isn’t that what this blog is all about? Well, first of all, the link between trauma and depression is widely understood and accepted. According to the National Center for PTSD, “ depression is a common problem that can develop after trauma”.

A survey of survivors from the Oklahoma City bombing back in 1995 showed that 23% had depression after the event. A well-known study conducted by Dr. Frank Putnam emphasized the connection between childhood sexual abuse and depression (major depression and dysthymia) while also noting that trauma may alter the clinical presentation of depression in clients. Anyone who has been depressed knows that the episodes are usually precipitated by some adverse event (e.g., getting fired; a breakup). These events can be traumatic themselves or can trigger distress from previous unresolved trauma.

When clients come into therapy for depression, therapists usually spend the initial sessions gathering history and assessing the situation. Questions are asked about family history, when the depression started, what makes it worse, past episodes of depression, and so forth. In nearly every case, these lines of inquiry lead the client to share about painful experiences in the past (i.e., “trauma” or adversity, whatever you want to call it!). Because of this link, and the idea that depression can often be a symptom of trauma, EMDR represents a powerful and effective option. Many clinicians understand that, while treatments like medication can help with alleviating symptoms, it’s critical to address the underlying issues.

Treating Depression with EMDR

Since EMDR involves reprocessing insufficiently processed distressing memories from the past, the goal of the EMDR therapist is to identify the root experiences that cause or influence depressive symptoms. These can be traumatic events that led to depression directly, or also traumatic events that set the stage for becoming depressed later. For example, if a person has low self-esteem, they may be more likely to become depressed following a rejection. Let’s just say the rejection triggers this underlying negative belief that he or she is not good enough which leads to a low mood. EMDR therapy could involve targeting and reprocessing the memories that created the low self-esteem in the first place!

The EMDR Protocol for Depression (DeprEnd) which some on the Mangrove Therapy team are trained in was created by Dr. Arne Hofmann of Germany and entails a modified approach for dealing with single or recurrent depressive episodes. The general process includes processing episode triggers (the precipitating event that starts the depressive episode), processing memories that contribute to negative belief systems (such as “I’m not good enough” or “I’m a failure”), processing memories with residual depressive emotion, and creating future templates to prevent relapse.

Case Example

Victoria has had periods of depression her whole life. This most recent episode started months ago with symptoms including very low energy, feeling sad all the time, having difficulty doing basic things around the house and going to work, and thoughts of suicide at times. She’s been in and out of therapy her whole life which has been somewhat helpful but never helping her truly feel okay, however she finally agreed to see someone after reaching a point of desperation. 

With a trusted therapist, Victoria started exploring the nature of her depression including how it has shown up throughout her life as well as corresponding distressful life experiences.

She recognized a pattern of becoming depressed as a kid following events involving her dysfunctional family of origin in which she felt totally helpless and out of control. She realized her mind and body were essentially shutting down in the face of what felt like insurmountable adversity. This most recent bout of depression started after getting into a major fight with her husband. 

Her therapist, trauma-informed and trained in EMDR therapy, helped her connect the dots between her depressive symptoms and the significant adversity she has faced throughout her life. Learning that her reactions have been understandable given her situation was really helpful in reducing shame and moving from the idea of “what’s wrong with me” to “what happened to me”. She started on an antidepressant medication to help with symptom management while making sure she was eating well while getting good sleep, support, and lots of consistent exercise. 

Then she and her therapist put together an EMDR treatment plan focused on reprocessing the unresolved negative experiences that contribute to her depression. Initial target memories included the recent fight with her husband as well as past traumas that occurred as a kid. This work was tough at times but Victoria was motivated to feel better and finally address her root issues. Over time, as these experiences were reprocessed, she started to feel better, more in-control, and “good enough”. 

Begin EMDR in Palm Beach County, FL

Our team of caring therapists would be happy to offer support in overcoming the distress depression can cause. Mangrove Therapy Group can offer support from our Palm Beach County-based practice and across the state. You can start your therapy journey by following these simple steps:

• Contact Mangrove Therapy Group
• Meet with a caring therapist
• Start coping with the symptoms of depression affecting you most!

Other Services Offered with Mangrove Therapy Group

EMDR therapy isn't the only service our team offers. Mangrove Therapy Group is happy to offer support with a variety of mental health services including trauma and PTSD/C-PTSD, substance use disorders, eating disorders, body image issues, anger management, anxiety, low self-esteem, personality disorders, and much more. Please feel free to learn more about how we can support you. We also offer support with addictions such as process addictions, grief and loss, “Failure to Launch” syndrome, CBT, and DBT. Feel free to learn more by visiting our blog or FAQ page to learn more today!