Over the past 35 years psychopharmacological developments have fueled major changes in the care of psychiatric patients. The most obvious of these are in two areas: (1) the control of symptoms not heretofore consistently treated effectively, such as the benefits of lithium in bipolar disorder, and (2) the shift toward reliance on medications rather than other forms of treatment. In this article I shall cover some of the implications of the second point, but will focus principally on other, less direct consequences of the development of specific pharmacotherapies for the practice of psychoanalysis. These areas are the enhanced importance of accurate diagnosis, the expansions of categories for which drugs are helpful, and the point, or framework, from which dynamic psychotherapies have their main indications.