These include adverse effects on identity, impaired agency, impaired affective competence, and negative effects on the patient's relationship with care. In this paper, psychosocial mechanisms, by which medications may cause harm, are explored.

These negative effects may be especially pronounced when noxious meanings and countertherapeutic aspects of medications are incorporated into the unfolding development of a child and not countered by psychotherapeutic experiences that allow iatrogenic meanings to be placed in context. While positive effects (e.g., the placebo effect) are broadly recognized, psychiatry is often less attuned to the negative effects that are mediated through the meaning of medications. Medications exert effects not only through biological mechanisms but also through the meanings that they carry. The authors propose that psychodynamic psychopharmacology advances the overall clinical effectiveness of medications with treatment-resistant patients by integrating a psychodynamic appreciation of the patient with a psychopharmacologic understanding. Common resistances to the effects of medications are considered, as well as ways that patients may become entrenched in treatment resistant illness from counter-therapeutic uses of medications.

The authors review the recent literature suggesting a major role for interpersonal and meaning effects in positive pharmacologic treatment outcomes, and suggest that many patients are 'treatment-resistant' to medications because an appreciation of the patient's dynamics is not incorporated into an understanding of repeated treatment failures. They also propose and define a discipline of 'psychodynamic psychopharmacology,' describe its philosophical underpinnings and make technical recommendations for the psychodynamic treatment of pharmacologic treatment resistance. The authors explore the phenomenon of treatment resistance in relation to medications.

Limitations by JD Riggs