Over the past 20 years, the previously frowned upon combination of pharmacotherapy and psychoanalytic or psychodynamic therapy has become common practice because of both findings from the neurosciences that demonstrate hardwired brain development from chronic early stress and trauma and from efficacy studies that show the superiority of combined therapy over either psychotherapy or medication alone. With this shift has also come a more focused interest in the psychodynamics of pharmacotherapy itself. This article will review some of the current thinking in this area and then present the personal approaches toward pharmacotherapy of two psychoanalysts, one at an academic hospital (RC) and the other in private practice (JS).