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.
Keywords: anxiety; behavioral pharmacology; depression; insomnia; personality disorders; psychodynamic pharmacology; treatment resistance.