Creative, person-centered and narrative psychopharmacotherapy or how to prevent and overcome treatment resistance in psychiatry.

Despite of the huge progress in clinical psychopharmacology and recent introduction of many new mental health medicines, a significant proportion of psychiatric patients do not respond satisfactory to pharmacological treatment. Such patients are commonly labeled "treatment resistant" although there is no full agreement about definition of the term. The precise prevalence of treatment resistance is hard to determine due to the lack of consensus regarding the term definition and too many cases of pseudo-resistance. Resistant and refractory mental disorders have significant economic, social, physical, and psychological consequences. The suffering and disability associated with chronic, unremitting mental disorders is profound. Changing treatment philosophy may be a critical step towards overcoming what some view as "therapeutic stagnation in psychiatry" and providing better treatment effectiveness and efficiency for patients benefit. A "paradigm shift" is needed from the mechanistic, formistic and reducionistic way of thinking of technical and impersonal psychopharmacology to contextual and systemic thinking with new treatment holodigm individualizing and personalizing psychopharmacotherapy in a more creative manner. Treatment resistance as a construct should be reconsidered as well as "monotherapy before polytherapy" treatment strategy. The best treatments are those that utilize and integrate multiple therapeutic modalities. The concept of creative, person-centered narrative psychopharmacotherapy gives a hope for increasing treatment effectiveness and efficiency in psychiatry.