Dr. Julia Ann Koretski reflects on the critical role of the placenta in drug metabolism and potential near- and long-term effects on postanatal life. The placenta was once viewed as a passive, almost mechanical barrier, but we are continuing to learn of the important ways it influences drug metabolism and development of conditions such as postnatal adaptation syndrome and schizophrenia. Dr. Koretski’s commentary is inspired by a Guest Editorial in the journal authored by Dr. Richard Shader, Founding Editor-in-Chief Emeritus of the Journal of Clinical Psychopharmacology. Dr. Koretski is Digital Editor of the journal.

Obsessive compulsive disorder (OCD) can often be effectively treated with cognitive behavioral therapy or serotonin reuptake inhibitors. About one-third of patients, however, do not receive adequate symptom relief. Jon E. Grant discusses the potential of monoamine oxidase inhibitors (MAOIs) in treatment-resistant OCD. In an article in the journal, Dr. Grant and his coauthors present new data from a case series of nine patients; three had marked improvement on phenelzine and three had some improvement. Large-scale trials are needed to fully assess the benefits and risks of the therapy in this population group.

Mass shootings have become a common occurrence in the United States and elsewhere. In this podcast, author Ira D. Glick discusses the research he and his colleagues conducted to analyze whether certain mass shooters had psychiatric illnesses and had received appropriate medication before they committed the violence. While the authors acknowledge the limitations in their research, their data suggest that many persons who commit domestic mass murders may have experienced compromising and untreated psychiatric illnesses.

Psychotic depression is a severely disabling illness and is more common than is generally realized. Unfortunately, there is no FDA-approved medication for its treatment. In this podcast, the Editor-in-Chief of the Journal of Clinical Psychopharmacology, Anthony J. Rothschild, discusses his opinions as to how this came about and encourages further research and development of a suitable medication with an eye toward FDA approval.

Authors Nicholas A. Mischel and Richard Balon discuss their commentary, “Esketamine: A Drug to Treat Resistant Depression That Brings More Questions Than Answers.” Their commentary asks: How does this treatment fit into the broader repertoire in treating resistant depression and suicidal ideation or behavior, with both concepts ill-defined?

Editor-in-Chief Anthony Rothschild discusses his editorial, “The Pitfalls of Psychotropic Polypharmacy.” For psychiatric disorders, it is common for patients to be prescribed more than one medication. While there may be benefits, it is essential that clinicians also be mindful of potential problems, such as pharmacokinetic interactions (affecting drug absorption, distribution, metabolism, and elimination), pharmacodynamic interactions (for example, serotonin syndrome, QT-interval prolongation, and lowering of seizure threshold), drug-induced liver injury, and falls in older patients. There are times when “treatment-resistant symptoms” are actually adverse effects of the many medications being taken.