IntroductionPsychotherapists working in armed conflict settings are exposed to a shared reality of war that has been shown to affect their personal wellbeing and professional functioning. Existing literature emphasizes self-care, supervision, and personal therapy as coping strategies, yet these may be insufficient under conditions of prolonged war-related distress. In such contexts, psychopharmacological medication may be used to manage stress and sustain therapeutic practice, but this phenomenon remains largely unexplored. This study investigates the prevalence, motivations, perceived effects, and ethical implications of psychopharmacological use among Ukrainian psychotherapists.MethodsA mixed-methods design was employed. An online survey (N = 103) assessed medication use, war-related exposure, and self-reported effects on mental health and professional functioning. Qualitative data included thematic analyses of five open-ended survey questions and two semi-structured interviews.ResultsMore than half of the participants reported current or past use of psychotropic medication, with 41.8% reporting current use and 85.5% continuing clinical work while medicated. Medication use increased markedly after the onset of the full-scale war and participants commonly associated it with war-related stress, grief, and disruptions in emotional and bodily functioning. Participants perceived medication as supporting emotional regulation, therapeutic presence, and boundary maintenance while enabling continued clinical work despite ongoing war conditions. Two interview participants illustrated contrasting patterns of use: (1) reflective, self-monitored medication aimed at sustaining professional functioning and (2) crisis-driven use associated with acute psychological distress.DiscussionThe findings suggest that psychotherapists working in wartime contexts operate within a distinct ethical landscape in which sustaining therapeutic presence and professional responsibility may involve new forms of self-regulation, including psychopharmacological medication. In this context, medication may become part of the efforts to maintain safe and effective clinical practice within a shared trauma environment. These results highlight the need for professional cultures that acknowledge therapist vulnerability and the adaptive strategies required to sustain therapeutic work in humanitarian crises.