Combination of psychotropics in psychoanalytic psychotherapy: psychotherapeutic challenges

Abstract

The case illustration is from a long-term experience of individual psychoanalytic psychotherapy with a male patient, who started therapy when he was 15-years- old. According to DSM-IV criteria, he was diagnosed with a major depressive disorder. A psychological assessment including a Rorschach test showed a poorly integrated but well-adapted Borderline-Narcissistic personality disorder. Various classes of ant-idepressant drugs were used with equivocal or uncertain effects, and the roots and causes of the patient's negative reactions to medication had to be thoroughly investigated and dealt with during psychotherapy. Pharmacotherapy might succeed in targeting the various symptoms of depressive states, but the psychodynamic approach in a psychotherapeutic relationship widens the scope and works introspectively, allowing the patient insights to understanding the symptoms. The use of a psychotropic agent is usually based on trust and belief in its expected effect, but often the effect is not as expected. The psycho- pharmacological drug is also imbued with manifest and latent meanings which can be reached at in the psychoanalytic report. Such meanings and expectancies, and the consequent reactions affect both the patient and the psychotherapist. They have to be dealt with and overcome by psychoanalytic understanding and intervention, as well as experience and skill in use of the medicine concerned.