[Psychotherapeutic considerations regarding medication treatment for refractory cases]

The aim of this paper is to consider the psychotherapeutic approach to refractory cases in a psychiatric clinic. Although standardized, formulated psychotherapies, i. e., CBT and IPT, have a limited efficacy against antidepressant-resistant or chronic depression, psychotherapy and medication treatment may complement each other in combination. However, the first step in the psychotherapeutic consideration of refractory depression is to give up seeking "a specific medicine" which does not exist. On the other hand, a doctor should give his/her patient new hope for recovery and stimulate their motivation for treatment. In the dialogue between a doctor and patient, the following points are to be focused on : 1) The essential part of treatment is not medicine but the patient him-/herself. 2) Recommendation of medication should not further reduce the patient's pride. 3) It should be clear that medication treatment is a collaborative activity between patients and doctors. It is preferable for topics of an interview to extend from a reconsideration of the prescription contents to reconstruction of the daily life. It may be helpful for patients to obtain detailed advice on basic lifestyle aspects, such as sleep, meals, and daily activities.