Eye Movement Desensitization and Reprocessing for Posttraumatic Stress Disorder in Bipolar Disorder

1 the mean prevalence of PTSD in bipolar patients is 16.0%, which is double the lifetime prevalence of PTSD in the general population. 2 Also bipolar patients with comorbid PTSD exhibit more severe bipolar illness and multiple Axis I disorders, and they disengage more frequently from treatment, suggesting poorer outcome and course of the disorder. 3,4 Trauma-focused cognitive-behavior therapy and eye movement desensization and reprocessing (EMDR) are considered first-line treatments for PTSD. 5 Nonetheless, evidence for the efficacy of PTSD treatment in bipolar disorder is lacking. This is an unsatisfactory situation given the fact that anti-depressant pharmacotherapy, often suggested as a second-line treatment for PTSD, has limited application for for bipolar patients because of the possibility of manic switch and adverse long-term outcomes. 6 We report here the successful administration of EMDR to two cases of PTSD in patients with bi-polar disorder. A 25-year-old Korean woman was hospitalized for recurrence of a manic episode that initially began three years earlier. Although her affective symptoms had improved, she was troubled by continuing PTSD symptoms that were initiated by multiple rapes 10 years previously. She was additionally diagnosed with PTSD according to DSM-IV criteria and she scored 52 (mild level of PTSD) on the Clinician-administered PTSD scale (CAPS) 7 ; while being maintained on antimanic medications , she was treated with 10 sessions of EMDR starting four weeks after hospitalization and continuing on an outpatient basis, which resulted in complete resolution of PTSD (CAPS score: 7). One year later, she remained in complete remission for PTSD and continued outpatient treatment for bipolar disorder. A 39-year-old Korean woman with a 20-year history of bi-polar disorder was diagnosed with comorbid PTSD, according to DSM-IV criteria, resulting from several traumatic experiences including an accident, sexual assault, and involunatry hospitalization that happened years ago around the time of onset of her bipolar illness. She scored 67 (moderate level of PTSD) on the CAPS and was given nine weekly sessions of EMDR starting one week after admission and continuing through discharge and outpatient treatment. After EMDR, her PTSD symptoms decreased to complete remission (18 on CAPS) and she maintained this therapeutic gain during one-year of follow-up. Both patients had PTSD for more than 10 years, and it is unlikely that spontaneous recovery occurred coincidentally with EMDR. Both patients received antimanic and antipsy-chotic medication concurrently with the EMDR sessions and it is theoretically possible that the recovery was …