Psychodynamic Insights into Treatment-Resistant Pharmacotherapy: A Case Study Exploring Patient–Physician Dynamics and Adherence to Evidence-Based Practices

Abstract

Background: Pharmacological resistance in severe recurrent mood and anxiety disorders remains a significant challenge in modern biological psychiatry. This case report investigates the intricate decision-making process employed by physicians when managing patients resistant to conventional pharmacotherapy. Methods: Informed consent was obtained from the patient. Following this, the case report was developed using the CARE checklist (2013) to ensure a comprehensive and systematic documentation of the treatment process and outcomes. Results: The patient’s treatment history highlights the complex nature of pharmacological resistance and the impact of minor medication adjustments versus established clinical practices. A crucial aspect of this case was the patient–physician relationship, particularly addressing the patient’s past grievances towards physicians, which played a significant role in the treatment process. Despite efforts to improve the physician’s confidence and approach, challenges such as lack of continuity and a fragile therapeutic relationship contributed to treatment failure. Conclusions: This case underscores the importance of psychodynamic models in overcoming pharmacologic challenges. A deeper understanding of the patient–physician dynamics and addressing underlying emotional factors can enhance treatment efficacy and patient outcomes, providing valuable lessons for managing complex cases of treatment resistance.