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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.
Baur et al. (Sat,) studied this question.