The Mission of JCP with Editor-in-Chief Marlene P. Freeman, MD

The Guest

Dr. Marlene Freeman is Editor-in-Chief of The Journal of Clinical Psychiatry and a professor of psychiatry at Harvard Medical School. She serves as Associate Director of the Center for Women’s Mental Health at Massachusetts General Hospital, where she holds the Abra Prentice Foundation Chair in Women’s Mental Health. Dr. Freeman is Medical Director of the Clinical Trials Network and Institute at Mass General and is a Fellow of both the American College of Neuropsychopharmacology and the American Society for Clinical Psychopharmacology.

Key Topics Discussed

• Dr. Freeman’s vision for JCP’s mission and editorial leadership
• Navigating peer review: guidance for authors and reviewers in psychiatric publishing
• Supporting shared decision-making and collaborative patient care in psychiatry
• Balancing scientific rigor with clinical applicability in research
• Emerging trends shaping psychiatric research, treatment, and publication
• JCP’s evolution: specialty sections, digital expansion, and credibility in the modern landscape
• The role of industry research, AI, and preprints in advancing psychiatric science

Episode Overview

In its inaugural episode, the JCP Podcast features a foundational conversation with Dr. Marlene Freeman, Editor-in-Chief of The Journal of Clinical Psychiatry, in which she discusses the journal’s core mission to empower busy mental health professionals with cutting-edge, evidence-based research. Providing insights into academic publishing, from the peer review process to the journal’s vision for psychiatric education, today’s discussion offers essential listening for those at the intersection of clinical practice and scientific discovery.

Dr. Freeman details her professional journey into women’s mental health and perinatal psychiatry, and goes on to explore how the journal balances scientific rigor with clinical relevance to support shared decision-making in patient care. Navigating the complex publication landscape, the episode addresses industry-sponsored studies, the importance of diverse voices, and emerging trends like digital therapeutics, biomarkers, and the potential impact of artificial intelligence on psychiatric research.

Further Reading

Study on valproic acid and pregnancy referenced in discussion of Dr. Freeman’s editorial work highlighting teratogenic risks. Freeman MP. Prescribing Guideline for Valproic Acid and Women of Reproductive Potential: Forget It Exists. J Clin Psychiatry. 2022;83(6):22ed14609.

Counterpoint article offering more nuanced approach to valproic acid use in women of reproductive potential. Goldberg JF Valproate and Weight Gain: A New Look at an Old Problem. J Clin Psychiatry. 2024;85(2):23com15213.

ASCP Corner: Ongoing series in JCP providing brief, clinically relevant reviews on important topics, freely available to all readers.

Clinical and Practical Psychopharmacology by Chittaranjan Andrade, MD: Excellent reviews and meta-analyses, particularly around psychiatric pharmacology and biostatistics interpretation.

Interested in becoming a peer reviewer? psychiatrist.com/jcp/reviewers/

The Host

Ben Everett, PhD, is the Senior Scientific Director for The Journal of Clinical Psychiatry and Psychiatrist.com, where he oversees editorial strategy, content development, and multimedia education initiatives. He is the creator and host of The JCP Podcast, a series that brings together leading voices in psychiatry to explore the latest research and its clinical implications. Dr. Everett earned his PhD in Biochemistry with an emphasis in Neuroscience from the University of Tennessee Health Science Center. Over a two-decade career spanning academia, publishing, and the pharmaceutical industry, he has helped launch more than a dozen new treatments across psychiatry, neurology, and cardiometabolic medicine. His current work focuses on translating complex scientific advances into accessible, evidence-based insights that inform clinical practice and foster meaningful dialogue among mental health professionals.

Full Episode Transcript

This transcript has been auto-generated and may contain errors. Please refer to the original recording for full accuracy.

00:00 – JCP Podcast Mission for Busy Clinicians

Dr Ben Everett (0:00)

Welcome to the JCP podcast. This show is an extension of the Journal of Clinical Psychiatry and Psychiatrist.com and is designed to support busy clinicians by offering thoughtful conversations on timely topics in mental health. Across episodes, we’ll explore multiple themes from interviews with authors of cutting-edge research to broader conversations that reflect the mission of the journal to provide lifelong learning through evidence-based peer-reviewed scientific information on the diagnosis and treatment of behavioral and neuropsychiatric disorders.

Or put more simply, we want to empower mental health professionals with cutting-edge psychiatric research and insights.

00:37 – Introducing Dr. Marlene Freeman, Editor-in-Chief

Dr Ben Everett (0:37)

Our inaugural guest today is Dr. Marlene Freeman. She serves as Editor-in-Chief of the Journal of Clinical Psychiatry.

Dr. Freeman is a nationally recognized leader in women’s mental health and perinatal psychiatry. She’s a professor of psychiatry at Harvard Medical School and serves as the Associate Director of the Center for Women’s Mental Health at Massachusetts General Hospital, where she also holds the prestigious Abra Prentice Foundation Chair in Women’s Mental Health. In addition, she is the Medical Director of the Clinical Trials Network and Institute at Mass General.

Dr. Freeman is a Fellow of the American College of Neuropsychopharmacology and a Board Member and Fellow of the American Society for Clinical Psychopharmacology, or ASCP, for which the Journal of Clinical Psychiatry is the official journal. I truly cannot imagine a better guest for an inaugural episode. Dr. Freeman embodies the values we hope to highlight in this podcast, scientific rigor, clinical insight, and a deep commitment to improving patient care. It’s an honor to begin this journey with her today. With that, it’s a pleasure to welcome Dr. Marlene Freeman to the JCP podcast.

Dr Marlene Freeman (1:38)

Thank you for having me.

02:36 – Choosing Psychiatry for Patient-Centered Impact

Dr Ben Everett (1:39)

Great. Well, look, we like to start,this is the very first one, but I envision starting every episode with the same kind of set of icebreakers just to try and get to know each other a little bit. So I want to start with the beginning.

What drew you into medicine? You know, did this start as a childhood dream of yours or kind of when you got to college or somewhere in the middle?

Dr Marlene Freeman (1:58)

So I did want to be a doctor from a very early age. I did not have any physicians in my family, so I have to say I didn’t have full informed consent. But in terms of interactions with family members having illnesses and receiving treatment, I thought very highly of physicians, and I also was very interested in science.

Dr Ben Everett (2:19)

And then what chose you to want to specialize in psychiatry in particular?

Dr Marlene Freeman (2:23)

So I started off in medical school with the idea that I was going to be a primary care doctor. I really wanted to do internal medicine or pediatrics. I didn’t even know what a psychiatrist did, to be completely honest with you.

So when I was rotating through the clinical specialties, I fell in love with psychiatry. I felt like it was the specialty where we have the privilege of getting to know our patients best. And I was also deeply affected by how much patients we saw were suffering.

The other thing I thought that was so important was that there were so many gaps in our knowledge about psychiatric disorders and how we treat them.

Dr Ben Everett (3:05)

Excellent. And, you know, as we went through in the introduction, really your career has embodied a lot of research focused on women’s mental health. What drove that, you know, specialization for your research practice and so much of a clinical practice?

Dr Marlene Freeman (3:21)

I started out with a focus on mood disorders and anxiety disorders, and I did a fellowship in biological psychiatry. But what drew me to women’s mental health was  the need. So as I trained through medical school, residency, and fellowship, I was actually surprised to learn how much we did not know as a field to appropriately treat women across the reproductive lifespan.

So I really saw the gaps and so really shifted to focus more intensely on meeting the needs of women across the reproductive lifespan.

Dr Ben Everett (3:59)

Excellent. Well, like I said, your work in women’s mental health has been incredibly important, and we definitely want to come back to that in another episode. But being our inaugural episode, we really wanted to focus on your role as editor-in-chief of the Journal of Clinical Psychiatry.

So with that, can you tell us about how you became involved with JCP?

04:19 – JCP’s Purpose: Clinician-Ready, Evidence-Based Guidance

Dr Marlene Freeman (4:19)

Sure. I just want to take a step back for a moment because I think what drew me to the work with JCP so much was clinical work and also clinical research. And one thing that I think is so pivotal to the work that we do is how we make risk-benefit decisions collaboratively with individual patients.

And so as healthcare providers, we want to be able to share what is known, what’s not known, really make collaborative patient-centered decisions. And we need more information to make those informed decisions, and we need the information accessible for clinicians. And so to me, that’s what the Journal of Psychiatry needs to do.

So we have to disseminate new information across types of therapy and also inform future research. And it always comes down to helping patients. So in terms of my involvement, I started out early in my career with the Journal of Clinical Psychiatry as a reviewer, a peer reviewer, and an author.

It was one of the first journals that I submitted my own work to, and I had no other direct relationship with the journal. After fellowship, I joined the faculty at University of Arizona, where the chair and my mentor was Dr. Alan Gallenberg, who was the editor-in-chief of Journal of Clinical Psychiatry before me. And he was just an outstanding mentor to me, and he involved me in the journal.

He really taught me the peer review process. So I started there by reviewing a lot of papers. I also then became a member of the editorial board, which was a huge honor for me, and then ultimately became the vice editor-in-chief while he was editor-in-chief.

And I’ve had the honor of serving as editor-in-chief for almost eight years now, and I could not be more thrilled with this position. It’s so valuable to me and means so much.

Dr Ben Everett (6:21)

Excellent. You know, I think what you hit on really does embody the mission statement of the journal, which is to provide lifelong learning for clinicians through evidence-based, peer-reviewed scientific information about the diagnosis and treatment of behavioral and neuropsychiatric disorders, which we abbreviate on the website sometimes or sort of make a little bit more concise, just say empowering mental health professionals with peer-reviewed psychiatric research and insights. And I think exactly what you said is what we’re trying to do and what we hope we do every day is by bringing this, you know, new clinical information, new insights to the busy clinician to help them, you know, better provide care for their patients. So that’s excellent.

You know, in terms of, you know, balancing scientific rigor with clinical relevance and in shaping the journal’s editorial direction, you know, how do you, how do you go about, you know, ensuring that we’re doing that?

08:03 – Faster Access to Research: Summaries, Email TOCs, Podcasts, Specialty Sections

Dr Marlene Freeman (7:17)

So I think our mission remains the same across the years. And I would like to hold steady in terms of keeping to our mission and doing the type of work that we do, receiving the type of work from investigators and authors and publishing what we see as the best, most clinically relevant information. I think in terms of the direction that the journal will go, I think we have opportunities to increase dissemination of new information and perhaps have more interactive experiences for users.

And I deeply appreciate that healthcare providers are so busy and overwhelmed, perhaps especially in our field and really have variable time for reading original works. So I think that in addition to the work that we’re already doing and the work that’s being done on our website, you know, I’d like to see us expand upon how we offer information. I think that it’s important too, that we link back to the original written work because some individuals may decide they want to read the full paper.

Some people might just want a summary of it. So I think we want to make the information as available as possible for people to have access to it. We’re also really excited about some of the new features of the journal and the website.

So our goal is to be as accessible as possible to provide information to clinicians. And I think we’re doing that. You know, it’s an evolving process of improving the website, making it more searchable, providing table of contents for our journal.

And launching this podcast, I think, is a very exciting new endeavor. I think emails can often be key in terms of knowing what research has come out. So you can sign up to receive the table of contents and we’ll have an email provided for this. (FYI – Dr. Freeman cued us including an email where they can sign up for the table of contents, so maybe we can include it when we post this on our site and on platforms)

But if you’re not receiving the table of contents and you want to, you know, please contact us. I think this is really important because then you can make the decision whether you want to actively seek out the full paper on a topic.

Dr Ben Everett (9:22)

Excellent. I think that’s one of the things we hope to do with this podcast, right? When we, you know, invite authors, corresponding authors or other investigators on cutting edge research to come and have a conversation about their paper, everybody learns differently.

And I think catering to those different learning styles is very important.

And of course, as soon as articles are approved, clear peer review and layout and all that sort of stuff, they’re electronically published on the website immediately.

But is there a concerted effort for each issue to have a theme or like a, you know, sometimes we’ll see a proposal or an RFP for pieces and things like that. Do we ever do things like that with the journal or is it just based on what submissions you get and going through and just making sure that we have, you know, the best quality, highest quality, scientific rigorous information?

Dr Marlene Freeman (10:18)

Well, I love that question because one of the things that I’m most proud of in terms of my contribution is starting specialty sections for the journal. For example, we have specialty sections in women’s mental health, child psychiatry, geriatric psychiatry, psychosis, and an early career section. And we could potentially build upon those with more themes, but we don’t want to wait to publish new research or papers.

So what we do these days, we’re so fortunate that we can publish things that have been accepted pretty quickly online. And then at our website, we can group things together. So we don’t have a theme for each publication.

And part of that is just the practicality. So we don’t want to hold up important papers so that we can publish them as collections, but we want to offer them as collections.

Dr Ben Everett (11:09)

Oh, excellent. Yeah, I love that. I know if I’m looking for something on schizophrenia, for example, I can just go straight to that section.

And it’s typically in sort of the most recent publications are listed first, and then you have some older ones after that. In terms of helping clinicians make better decisions, how do you think we can better support a shared decision-making and practice, especially how we communicate what’s known, what’s uncertain, that informed consent risk benefit conversation with the patients, and how patients can be active participants in their own treatment?

11:33 – Shared Decision-Making in Practice & ASCP Corner Quick Reviews

Dr Marlene Freeman (11:42)

I think that’s an excellent question. I think expanding upon how we make the information available is really key to that because it’s almost impossible for busy clinicians to stay up with publications, even if they have a specific area within psychiatry, it’s hard to stay up to date. There are so many papers that are coming out all the time.

So fortunately, we get more information, but we have to be able to determine what studies are designed in a way to deliver good information. We want to assess the quality of studies, and we want to also be able to look at what the preponderance of the evidence suggests to us. So I think that that’s something that we’re going to be working on in the future is how to provide reviews of that information and make it [as] available as possible.

One area that we’ve done that traditionally is the ASCP corner. So the American Society of Clinical Psychopharmacology has always had a very brief review of an important clinically relevant topic that is available to all in full, free, and it’s always the topic of clinical importance. So that section has been very important in delivering quick reviews, and I think that they are very valuable.

Dr Ben Everett (13:03)

Yeah, good stuff. Just speaking of how much information is available now and how many articles come out now, I read just recently that the number of publications is increasing dramatically. So in 2014, there were about 34,000 peer-reviewed journals.

By 2020, so just six years, that number had grown to 46,736, very specific number there. In an increasingly crowded publication landscape, how do you ensure that JCP remains trusted and credible source for clinicians? I think some of this we’ve hit on, but is there anything in addition you want to bring up?

Dr Marlene Freeman (13:39)

So the field has changed in terms of the development of many, many journals that are published online. Some require a fee for publication. It’s very hard for clinicians to sort out what are credible sources and what are not.

So I think it’s very important for clinicians to go to trusted sources. And also, many of the listeners receive invitations to peer review for maybe all of those journals. So I received many invitations to peer review for journals I’ve never heard of or are wildly outside my specialty.

One thing that I would suggest, so that people aren’t overwhelmed, is pick a few journals, a small number that you follow regularly, that you submit to, if you’re an author, that you peer review for as part of that community. Try and stay focused because there’s so much distraction out there. And so instead of trying to weigh each journal for its merits is to really know a few of them very well.

Dr Ben Everett (14:42)

Yeah, I think that’s great advice right there. Well, moving into manuscript selection and this peer review process that we’ve mentioned several times so far, you stated that your kind of introduction to general clinical psychiatry was through your mentor who invited you to be a reviewer. You’ve reviewed, published hundreds of scholarly articles.

When it comes to new submissions, are there any key elements you look for in determining whether a manuscript might be a good fit for JCP, certain criteria? And let’s just, for the sake of time, let’s assume that it meets all of the editorial constraints, it’s formatted properly and all those types of things.

15:11 – What JCP Publishes & How Peer Review Ensures Clinical Quality

Dr Marlene Freeman (15:21)

So we look for and receive a lot of original research papers that affect clinical care and will impact future clinical research. And we’re always excited about new novel treatments in areas where we need them. So that’s one area.

We don’t publish a lot of narrative reviews, but we do publish systematic reviews and meta-analyses as well. I have to say that I am not a huge fan of individual case reports because they can sometimes misinform clinicians. To this day, there are case reports in perinatal psychiatry that N equals one that still affect the field after much more rigorous and larger studies have been done.

So I’m very, very careful about case reports. So in terms of, I want to demystify the process for potential authors. And so individuals submit their manuscript, but even before submission, we are happy to be contacted by authors to have an email exchange to see if it’s an appropriate fit.

We want to be user-friendly to authors. We want to save them time. So if we’re not a good fit for their paper, I’m very comfortable looking at whatever people want to send me in advance.

So either the topic or an abstract of the full paper, whatever people feel comfortable sharing. Because if we’re not the place, I want them to find the place for publication as quickly as possible. So once we receive a paper, we determine whether we’re going to send it out for full peer review or not.

And very often, we reject papers that are perfectly fine because I really want to emphasize that a rejection doesn’t mean that the work isn’t high quality, but we look at what’s already been covered in the literature, what’s new and novel, what’s going to inform clinical care. Again, we’re looking for fit with the journal and what also is in our own pipeline coming up for publication. And so I want to say, I really want to emphasize that a rejection of a paper doesn’t mean it isn’t high quality.

So if someone is involved in clinical research and academic writing, rejection is part of the job. But especially for early career individuals, it really stings. It really hurts when you’ve worked so hard on a paper and then it gets rejected.

So part of the issue for us too, if it’s not a good fit, is that we don’t want to call upon peer reviewers for their time, which is also precious, and we don’t want to hold the paper up. So if there’s a quick rejection of a paper, we’re trying to do a favor for the authors actually so that they can get their paper published as quickly as possible somewhere else. But I also appreciate that a quick rejection doesn’t feel good.

And so I want to just make clear that it’s not a reflection on the very hard work that went into the manuscript. So after a paper comes to us, we really search for peer reviewers that are going to be appropriate in analyzing the science, the rigor, and the clinical impact that the paper might have. And it is increasingly difficult to find peer reviewers because as we were talking about before, individuals who are clinicians, researchers are pressed for time probably now more than ever.

And so we often have to ask many peer reviewers to review a paper before we get adequate peer review. And usually the lag in time for a decision is the quest to find the reviewers and get the reviews back, which are just gold to us. It is so precious, and it’s an anonymous process.

So individuals who peer review get credit by being on a list at the end of the year and with our gratitude, but it’s really a very selfless activity that is so necessary to the field and the work could not be done without peer reviewers. And so I just want to make a plea for anyone who is listening who would want to serve as a peer reviewer to contact the journal because we’re always looking for individuals who would want to peer review. For potential peer reviewers, the comment I hear most frequently why they don’t accept the invitation to peer review is that they don’t feel comfortable about some aspects of the paper in terms of their own knowledge.

So the area that comes up most commonly is people’s discomfort with biostatistics. So I think it’s incredibly helpful for people to provide us a review and just state they can’t comment in a certain part of the paper, but give us the sense of where this fits in the field. How important is it potentially to the field?

Because we’re calling upon those reviewers for specific reasons. And so even if someone is just telling us where they think it fits clinically and that’s where clinicians’ voices are so important, we really want to have those reviewers.

Dr Ben Everett (20:21)

Excellent. We’ll make sure we put contact information in the show notes. Ben has cued us to include contact info to become a reviewer in the show notes. So if anybody is interested in becoming a peer reviewer, they can send us an email with contact information and we can get that to Dr. Freeman and the rest of the editorial board. It really is so critical, the scientific process, scientific method, that things be appropriately peer reviewed. You know, without the peer review process, I think it’s kind of like, where are we?

Dr Marlene Freeman (20:43)

And once we have the peer reviews back, then we act as quickly as possible to make a decision about paper. Some are rejected, some are accepted. And I feel one of the most difficult parts of the job is finally accepting a paper.

Because we’re going to put information out there that can be read by many, many healthcare providers and will be public information. And we want to make sure that we’re providing excellent clinical information and information that’s going to inform our field. So if a paper is rejected, I don’t at all want to sound callous, but if a paper is rejected after we’ve peer reviewed it, I hope that the authors will use the peer reviews to improve their paper and publish it elsewhere.

But I’m confident that so many of those papers will find a home in terms of a journal. But that’s why accepting a paper, though, feels so weighty because, you know, we want to make sure, ultimately, that patients who need help receive information and that their healthcare providers receive information that is the best quality we have to offer.

Dr Ben Everett (21:50)

Yeah, excellent, excellent. On this theme, are there any common mistakes or oversights that you see in papers that come into the journal? Any advice you could give to people in terms of, hey, we see this all the time, can you please just make sure you address this?

Or is it just paired, you know, paper by paper?

Dr Marlene Freeman (22:08)

Just to speak to junior authors and investigators, I think it’s critical to have peer review in scientific writing. So that can include everything from formatting, you know, shaping a paper. I think it’s really essential to have mentorship on writing introductions and conclusion sections, which can be so meaningful to the field.

You know, how to interpret the data if it’s an original research study. I think that doing a lot of peer review in writing is essential for growth in this area for our junior colleagues. And I think it’s one of the things we do see is that early investigators often don’t know that they need ethics approval for their work, even if it’s de-identified data.

So that’s also one of the things we look for is institutional approval. You know, see that something has gone through a rigorous IRB approval before a paper is published. And so we occasionally see that.

It’s usually not something that’s missed. And then the other thing that I would have to say for our journal specifically is that there are a lot of excellent authors who are researchers and don’t have clinics. They’re not delivering clinical care.

Maybe they’ve never delivered clinical care and their work is still vitally important, but I would suggest that they team up as authors with someone who does so that whatever work is being done can really be delivered in a paper with a clinical context. Lastly, I just want to touch on the fact that the Journal of Clinical Psychiatry is devoted to providing information on new and upcoming exciting treatments in our field, novel treatments. And because of that, we do see a lot of papers whose work is sponsored by industry.

So that could be related to a new medication. It could be related to a neuromodulation product. It could be related to an app.

It could be related to some copywritten form of psychotherapy. So whenever that’s the case, we want to make sure that there are all disclosures provided. And we want to make sure that the paper is written in a way that’s fair and balanced.

So I have to say one of the things that I learned early in my career in working with a journal is that, you know, the gold standard early in my career that I was taught was federally funded research was the gold standard. And very often clinicians, you know, sort of scoff at industry-funded papers. But what I learned is, you know, and any of you who are researchers who’ve received federal funding, those are tight budgets.

So we do the best we can with limited resources. But industry, because they’re often going for FDA approval, there’s a requirement to meet a certain level of rigor and size of trials. They often commit just a vast amount of resources for their studies.

And some of those studies are done so much better than we can do in academic medical centers without such funding. So that was one of the things that surprised me about working for the journal and also for our clinical trials network and Institute at Mass General. But we always want to make sure whoever the sponsor may be of a paper, that the material is fair and balanced and we’ll either reject papers that are not or we’ll peer review them and ask for changes until they meet our standards.

That’s something that has changed dramatically, I would say, over the past 20 years as we used to get a lot of papers that seemed more like marketing. That doesn’t happen very much today and we’re very glad about that.

25:11 – Promoting Diversity, Inclusion, and Ethical Publication Standards

Dr Ben Everett (25:50)

Yeah, excellent. How do you see JCP’s role in including diverse voices within the field?

Dr Marlene Freeman (25:55)

So at the core of our work is impacting patients and their families. So we are very open to receiving papers about any specific community, any research that’s related to access to care or implementation that will reach the most people. And over the last few years, we’ve also had more diversity on our editorial board.

We need that among peer reviewers, authors, and it’s very important to us. So we want to make sure, like any other paper that we receive, that we only are putting out the highest quality studies. I think that your question really underscores the fact that we work with vulnerable populations as clinicians.

We want to be so careful in the information we’re putting out there so that the clinicians who are on the front lines with any community have the best information possible.

Dr Ben Everett (26:50)

Yeah, really nice. Let’s kind of move on to sort of emerging trends and our topics and trends in the literature and in science in general. Are there any, you know, emerging trends or topics in psychiatry that you hope to see more of in upcoming, you know, issues or submissions?

27:00 – Emerging Priorities: Novel Treatments, TRD, and Real-World Effectiveness

Dr Marlene Freeman (27:09)

We are always interested in novel treatments, novel new treatments that are rigorously studied. And so there are just still so many gaps in the field, you know, how to make sure that the right treatment is provided to an individual patient or that patients have a menu of options that’s reasonable to choose from. I had a colleague who came up with that phrase, menu of reasonable options.

We want to make sure that we’re making collaborative decisions with patients, but we have to make sure that we’re offering good choices. And I would just add to that that no treatment should not be on the menu if someone is really suffering. So we want to make sure that there are enough choices and accessible options for people to choose from.

And so that’s really important to the journal. The other area, you know, is that we have so many treatment-resistant illnesses. And so there’s still an important place for research in those areas.

And we also have medications with serious side effects that we need to work on treating as well. So either avoiding side effects completely or for patients who need a certain drug, how to manage the side effects. So that’s also very important around our psychopharmacology topics.

So another area that is very important to us is not only efficacy research but effectiveness research. So how treatments perform in the real world with patients who may not qualify, may not be eligible for a treatment study with very rigorous inclusion and exclusion criteria, because we want to make sure that the treatments do work in the real world in the hands of clinicians that are in the community. So we also want to figure out like from the get-go how to match patients with certain treatments.

And I think as a field we are just not there yet. I would also add that we’re still working on fine-tuning our ability to make precise diagnoses and also screen for illnesses. And we want to make sure, I think it’s so important, that we always think about accessibility to treatment and education of our colleagues and patients.

So we want to keep in mind that patients live in diverse settings, have sometimes very limited resources, and we want to make sure that we’re providing treatments that everyone can access.

Dr Ben Everett (29:27)

Yeah, accessibility. I think you hit on a couple of different areas of accessibility there, right? Because there’s certainly cost but there’s also just like geographic location.

So many patients live in rural areas where if you’re in a major metropolitan area, you’re close to a teaching hospital, you can usually, you know, readily access quality care. But for so many Americans and really people all over the world, they live in more rural areas where they don’t have that access. And so, yeah, trying to find ways that we can increase access to all these new therapies, therapeutics, whatever it is, I think is critically important for really raising the bar for everyone.

All right, so, you know, as a follow-on to that, are there any, areas of research maybe you’re particularly interested in or excited about, you know, digital therapeutics or biomarkers to help guide treatment choices and decisions, health equity, anything that you feel is really underrepresented in the current literature or something you’re personally excited about?

30:24 – Digital Therapeutics & Biomarkers Must Prove Clinical Utility

Dr Marlene Freeman (30:24)

So I think those topics are all very important, but I really want to underscore the importance of rigorous research for any treatments that we’re offering. So as far as digital therapeutics go, you know, we see a lot of telehealth platforms now, we see a lot of apps out there, and most of them are not rigorously researched. So they may be directly available to the public, but the public doesn’t necessarily know about the quality of what they’re using.

So I think if we can receive more rigorous studies and be able to publish upon those on digital therapeutics, you know, we would welcome those. In terms of biomarkers, I would say we are most interested in biomarkers where we can see a direct line to clinical care or clinical research or personalized medicine. And so, you know, just biomarkers, you know, we don’t do basic research, you know, we’re not focused on topics that are so preclinical that we don’t see a direct line to affecting patients.

Dr Ben Everett (31:21)

Yeah, and I think that’s one of the things that really complicates clinical care in psychiatry. I’m a basic scientist, but you know, I read a lot, and a lot of these disorders will present with varied symptoms. You might have a lot of choices for anti-psychotic or whatever it is, but it’s trying to find the right medicine for the patient in front of you, and that can be difficult.

And with psychiatry, we don’t have the luxury of like an A1C to help guide, you know, glucose control or blood pressure, millimeters, mercury. And I think that really cuts across a lot of medicine where the biomarkers just aren’t that directly correlated to treatment decisions and treatment care. And I think that’s why, you know, we’ve just got to have great research and good tools to help inform clinicians.

As a follow-onto that follow-on, there’s always new information coming out on-label, off-label, these types of things. You know, in terms of like the industry-sponsored clinical research, you hit on inclusion-exclusion criteria. You know, when industry funds a study, they are in the most ethical manner possible trying to, you know, test a patient group that they think will result in an efficacy and safety profile that is good enough to end up with a new drug application that will eventually be approved.

But so many patients do not fit into that inclusion-exclusion criteria. And so we end up with this, well, that’s an off-label patient, or I don’t know, we don’t have much evidence in patients with, you know, more severe renal disease or hepatic disease or whatever it may be. Is there an area for additional research in those things?

Dr Marlene Freeman (33:03)

Okay. So first of all, I would emphasize that we don’t assume that papers from industry are going to be high quality. We judge them like any other paper.

So many of them are rigorous and ethically done and just top-notch quality, but many of them are not. And so we always try to stay conscious of any financial motives for a company submitting a paper. And fortunately, the papers that we receive are generally important in terms of informing the field and the development of new treatment options.

But we always, you know, remain neutral on that, like whether the paper is good or not good. And, you know, sometimes we really need our absolute best peer reviewers, the most experienced in the field to really judge that. So we want to make sure that what we’re putting out there is not a result of the financial investment that a company has made.

We want it to be based, you know, purely on the research and what it has to add for patients. And again, it’s a heavy burden. We don’t want to put anything out there that would negatively affect patients and their families.

That’s extremely important. I would add too that in terms of this work, you know, I definitely don’t do this by myself. We have an excellent team of section editors, our vice editor-in-chief, Dr. Joe Goldberg. We have excellent editorial board members and we have peer reviewers that are so incredibly generous with their time. And so that helps us with our mission. And I wanted to mention that we also have an early career section where authors can note whether they’re early career, and we have the definition of that on our website, and they’re received differently.

Those papers are received differently or, you know, in a separate pile, basically. We do not lower the bar for publication in terms of meeting our standards, but we try and keep in mind that someone is more junior and try and make it as much of an educational experience as possible as they go through submission and peer review.

Dr Ben Everett (35:05)

Great. You touched on this a little bit earlier, but, you know, we’re talking about all the, you know, the increase in the number of journals that are available. How do you see open access, preprints, evolving publication models influencing how scientific and clinical research is shared and consumed?

Dr Marlene Freeman (35:23)

So I’m not an expert on some of these things. You know, I do understand that the requirement from some funding agencies for open access, I think open access is great. And I love when I can go to PubMed and read a full paper.

And my understanding of the preprint process, though, is different. So we’ve talked about the importance of peer review, but my understanding of a preprint process is that a paper hasn’t rigorously gone through the same process. And I believe that was due to the idea of putting out information in the case of a public health emergency.

But I think it’s being used more broadly these days. And I just think we have to be careful with information that has not been fully peer reviewed.

Dr Ben Everett (36:07)

Yeah, well, what’s your perspective on the role of AI and psychiatric research and publishing, whether as a tool or as a topic for debate?

36:02 – AI in Publishing: Verify References and Read Full Papers

Dr Marlene Freeman (36:16)

So I have mixed feelings about AI and its role in publishing and it’s role in our society in general. And I’ve experimented with it a little bit. And in the scientific realm, I’ve tried to find information about a topic, used it and was in some cases very impressed by the summary of information that it provided.

Also, just this week, I did a search on perimenopausal depression and found that the information was high quality, but the references were incorrect. And specifically, I was credited with being the first author of a paper that Dr. Ellen Freeman was first author on. And so I think it’s, you know, I’m not sure it’s ready for prime time.

I fear that people think it is. And so as we have all these busy clinicians who are trying to do their best to get information quickly, I’m worried about an overemphasis on AI to get information. I’m also very worried about AI being used to write papers.

So there’s no way as editors that we can know if AI was used. So we do require authors disclose that if they used AI. But I think we never truly know.

So I think that what we’ll probably see is AI being used quite a lot in research of the topic. So, you know, as we have authors using AI, I think they’ll probably get information about, you know, background of their topic, references and things like that. And I would just urge people to be so careful and check everything to make sure it’s correct and to make sure it’s not plagiarism, because that’s potentially another problem with AI.

Dr Ben Everett (37:59)

Yeah, I’ve noticed the same thing withresearch and just asking basic questions. Sometimes it’s really accurate. Other times you can’t understand where the information is coming from.

But specifically with references, it really seems to struggle with  getting references right. I’ve even like, oh, give me a PMID for that reference you mentioned. And the PMID like either doesn’t pull anything up or will pull up a completely different paper.

And so just, yeah, a lot of room for improvement there. Fun to play with, maybe.

Dr Marlene Freeman (38:27)

I also think there’s a risk of health care providers and the public reading information from AI and not getting the richness of the original paper. So I would encourage anyone who is interested in a specific topic and really wants to understand it to go to the original paper. You get so much out of reading papers and I’m afraid people are really so busy and are discouraged in terms of having the time to do this, but it’s so worth it.

So if you’re interested in a particular topic, you get so much out of reading the full paper. So there’s the abstract, but the introduction section is like a mini review of that topic and gives you so much more information. And then it’s even if you’re not a researcher, it’s important to just see how studies are conducted.

You may not want to spend a lot of time on the biostatistics if that’s not an area of interest for you. And I think the discussion sections that we have are so important because it helps put the work into context and also offers areas for future directions.

Dr Ben Everett (39:29)

I love reading a good discussion because it does. It puts it in context, at least how the authors find the findings in context. There could be subgroups that saw additional benefit or maybe additional harm and things that you might not pull through if you’re just kind of glancing at the abstract or through the results.

And so I encourage people just to read a paper all the way through and make sure they pay close attention. But it is difficult as people have so much time or there’s so many demands on their time now. Well, look, kind of drawing to the end of our time together here, just some closing reflections.

You know, you wear a lot of different hats as a researcher, clinician, editor. How does this role as editor-in-chief complement your other roles?

40:00 – Clinician-First Perspective: Practice Informs Editing & Research

Dr Marlene Freeman (40:13)

I think it’s a great question. I think they all complement each other. For example, from my clinic, I really can note where the gaps are in treatment in the real world.

And so I thinkwe can take that back to our research team and decide to research some of those questions that will directly impact our patients. And I think that also informs the role of editor. However, I think that the most crucial role is that of being a clinician for me because everything else is improved by the fact that I’m a clinician.

So I think my research is better. I think my role as an editor is better, not only because I see sort of the direct, you know, where the information is going to be directed and what the ultimate outcome might be of putting information out there. It also reminds me every day to be so careful with what we’re putting out there.

I would also say that as having done research, I really think that I can appreciate a lot of aspects of research papers that I would not be able to understand, you know, had I not done research myself. So I think I would be able to understand the scientific topics, and I read many papers that are not in my area of expertise. But I think it’s important to be able to look at methods and outcomes and the discussions and really sort of as a visceral level know, like, how hard was this sample probably to recruit?

Or, you know, to pay attention to recruitment rates, dropout rates, things like that. And also the burden of research on the patients is also very important to note. And so, you know, I think that all the roles inform each other, but at the heart of it, I’m a clinician.

Dr Ben Everett (41:55)

That’s awesome. I’m hoping you can share a moment or maybe an article. You know, you’ve been involved with the journal for a long time, starting as a fellow or junior faculty member, doing reviews to now eight years as editor-in-chief.

A moment or an article from JCP’s history that’s really had a lasting impact on you?

42:03 – Editorial Impact and Evolving Ethical Responsibilities

Dr Marlene Freeman (42:16)

Well, just speaking to the process, I would say, you know, some of the most impactful experiences are interactions with authors. So back and forth, you know, communications with authors, whether the paper is of interest, providing them feedback, maybe working with them extremely carefully in some cases to get the paper where it needs to be to be publishable. And I found that authors really appreciate that from an editor and that the end result, we’ve published just so many amazing papers.

I can give an example of work that was extremely important to me recently, where a lot of our talents, I think, really overlap and shine for the journal. And this is from my work in women’s mental health and perinatal psychiatry. We’ve had a number of studies published, as have other journals, on the risks of valproic acid in pregnancy.

And so in that context, I personally teach that valproic acid should not be given to an individual with reproductive potential or girls younger than reproductive potential because it is so teratogenic. Risks can occur before someone even knows they’re pregnant and there are neurodevelopmental problems subsequent to even the first trimester at risk. And so we’ve published some of those papers, and our colleague and section editor, Dr. Chidu Andrade, has done excellent, excellent reviews on the topic and is so careful also in terms of providing readers with explanations of biostatistics if they ever want that. So he’s really a treasure in terms of summarizing papers and meta-analyses. But in terms of a paper that highlighted the risk of women not using contraception, not informed of the teratogenicity of valproic acid, I wrote an editorial, one of the ones that I’m most proud of writing. And it might not sound like a big thing to everyone.

It was a short commentary, and it was titled, Prescribing Guidelines for Valproic Acid and Women of Reproductive Potential. Forget it exists because I feel so importantly that it not be used. Yet I also think that there’s room for academic exchange.

So we had a counterpoint by Dr. Joseph Goldberg, who took a more nuanced approach, like where it might fit in pharmacology and treating women of reproductive potential. Now, I have to say, I don’t agree with him, but there’s room for disagreement in our field where there might be high risks at stake, not only the illness, but also the treatments.

Dr Ben Everett (44:55)

Yeah. Thank you for sharing that. I think really your passion for your patients comes through in that, but also for your colleagues and understanding that there is nuance to medicine and, you know, while it might not be right for you, another clinician might decide for this patient, you know, that the risk is the benefit is worth the risk.

So, and really, I think that just highlights what we’re attempting to do with the journal is making sure that clinicians have the right information to make these sometimes difficult decisions for their patients. Finally, what do you find most rewarding and maybe most challenging about serving as editor-in-chief?

45:18 – Reflections on Leadership, Legacy, and Lifelong Learning

Dr Marlene Freeman (45:31)

I think it is the final decision to decide to publish a paper, as we talked about before, but I would say that every aspect of it, even the most challenging aspects, are truly rewarding. And serving as an editor makes me more familiar with every topic in our field because I spend a lot of time on PubMed looking up papers that have recently come out or the history of the research on a certain topic. And that’s also where I find peer reviewers, but also give myself the background knowledge to assess a paper.

So, I think it really helps keep me up to speed on so many areas that I am not an expert on for my clinical work.

Dr Ben Everett (46:10)

Well, Dr. Freeman, thank you so much for joining me today and sharing your vision and insights. It’s been a pleasure having you on the first ever JCP podcast.

Dr Marlene Freeman (46:18)

I really appreciate being part of this inaugural podcast. Thank you so much for having me.

Dr. Ben Everett (46:24)Perhaps we can have you again in the future and we can discuss your research and women’s mental health. I want to invite everybody to join us next time. Dr. Joseph Goldberg, Deputy Editor-in-Chief of JCP, is going to be joining us. Dr. Goldberg is Immediate Press President of ASCP and we’re going to discuss his leadership with the organization and the involving role of ASCP in advancing psychiatric education and research. We hope you’ll join us. This has been the JCP podcast.

Insightful, evidence-based, human-centered. Thanks for joining us. Until next time, stay curious, stay informed, and take care.