Family expressed concern about mother’s medication before prosecutor says she killed three children

Linsday Clancy and her husband expressed concerns about the medications that she was taking for postpartum depression — and whether she had become addicted — in the weeks before she killed her three children and jumped from a second-floor window, court documents show.

Clancy, 32, was arraigned on murder charges and other offenses at a Plymouth District Court on Tuesday. She appeared remotely, laying in a hospital bed in Boston. Doctors said Clancy is paralyzed from the waist down.

During the hearing, attorneys from both sides of the case made it clear that Clancy's treatment for postpartum depression will play a role at trial.

"On some level this case is going to — inferentially, sort of — put the whole mental health system, as it regards to this very serious, little known, little resourced condition and disease, on trial, so to speak," said attorney Brad Bailey, a former state and federal prosecutor who has also defended clients in cases involving the question of criminal responsibility.

Clancy's attorney Kevin Reddington argued that his client was suffering from postpartum depression and overmedicated, so she not criminally responsible for killing her children on Jan. 24. Assistant Plymouth County District attorney Jennifer Sprague said Clancy had been functioning normally, and that she deliberately planned the murders.

The police statement of probable cause for Clancy's arrest contains summaries of interviews with those close to the Clancy family. Kyle Carney, a friend of Clancy's husband, Patrick Clancy, told police that about a month before the children were killed that Patrick Clancy said that his wife's postpartum depression medications were "not working" and thought his wife was "prescribed too many medications."

Carney also said that Patrick Clancy told him his wife was having trouble sleeping and was addicted to Benzodiazepines, a depressant often used to treat anxiety. Carney said Patrick Clancy "was really concerned about the withdrawals and said that Lindsay had the worst side effects possible."

Defense attorney Reddington said Clancy was prescribed more than a dozen medications between October and January, including a mix of antidepressants, antipsychotic medications and drugs to help with insomnia.

Lisa Cosgrove, a clinical psychologist and professor at UMass Boston, researches the prescribing of psychiatric medications. She didn't want to comment on Clancy's case specifically, but said too often multiple drugs are given to a patient — something she calld "irrational polypharmacy."

"Psychiatric medications such as these are unfortunately not monitored carefully enough, and there is a tendency in the U.S. to add another agent to address the side effects of the first one — or because the first one isn't working — and thus we too often see irrational polypharmacy," Cosgrove said.

But Dr. Nancy Byatt, perinatal mental health expert at UMass Chan Medical School said many times psychiatrists are just trying to help their patients get relief.

"Often when multiple medications are used it speaks to the severity of the illness," Byatt said. "There's no evidence to suggest that using multiple medications increases the risk of tragic outcomes. What we do know increases that risk is under-treatment."

The bail argument from the Plymouth County District Attorney's Office said that on the day the children were killed, Lindsay Clancy took her 5-year-old daughter Cora to the pediatrician and later sent her family photos of the children building a snowman.

"There was no indication that she was going to harm the kids," Sprague wrote in the bail argument. "No one described her as acting like a zombie in the days leading up to the murders or on the day of the murders."

Sprague said Lindsay Clancy received inpatient treatment at McLean Hospital for five days in January, after which she "appeared to be getting better" and kept a "medication diary."

"When she had issues with the medication, her doctor had her stop it or wean off it and then try something else," Sprague wrote. "She was never on more than four to five medications at a time, and at the time of the murders she was taking three medications. She always took the medication as prescribed."

Lindsay Clancy called her husband Patrick earlier this week, according to Sprague, using the cellphone of Dr. Paul Zeizel, the forensic psychologist evaluating her at her defense attorney's request. Sprague said Lindsay Clancy told her husband that she heard "voices and had a moment of psychosis" and a man's voice told her "to kill the kids and kill herself because it was her last chance."

"Patrick Clancy told the police that defendant had never heard voices before," Sprague wrote. "He also told the police the defendant had never said the word 'psychosis' to him before. The first time she used the word 'psychosis' was when she was with the doctor hired by defense counsel and using his phone."

After the court appearance Tuesday, Zeizel said he is still evaluating Clancy but it appears she could have been suffering from sudden hallucinations.

“These are people who one day will be functioning well, but because they have the onset of command hallucinations, which they adhere to and they believe the voice, they have to do something," Zeizel said. "That's when tragedy occurs.”

Many mothers experience changes in mood or postpartum depression after giving birth. According to the Massachusetts Child Psychiatry Access Program for Moms, one in seven women experience depression during pregnancy or in the postpartum period.

UMass Chan Medical School's Dr. Byatt said many new moms don't seek treatment because of stigma or fear that they could be deemed unfit and their children taken away. Byatt said psychiatric illness is not a reason to remove a child from a parent, and a doctor would not be required to report an illness to child welfare agencies unless there was concern about imminent harm.

About one to two in 1,000 women will experience postpartum psychosis, according to the Massachusetts General Hospital Postpartum Psychosis Project, which declined to comment for this story. The Project's website says postpartum psychosis is a more severe mental health condition than postpartum depression and includes rapid and uncontrollable mood swings, depression and/or mania. Most women with the postpartum psychosis will need to be hospitalized, according to the Project website.

The nonprofit Postpartum Support International says of the women who develop postpartum psychosis, there is an approximately 5% suicide rate and a 4% infanticide rate associated with the illness.

"A lot of postpartum psychosis involves people who may have altruistic delusions," Dr. Byatt said. "They may think 'I need to remove myself from the baby, and the baby from the world, because the world is better off without us,' or they think that they're saving their baby from a life of torture. Their brains are hijacked by a serious illness."

Attorney Brad Bailey expects a trial would focus on postpartum psychosis, combined with the effects of the medications Lindsay Clancy was prescribed.

"The primary focus of the defense here is going to be a lack of criminal responsibility based on the suspected underlying condition of postpartum psychosis," Bailey said. "The medication will be an aspect that I think that will be presented to emphasize how sick she was and how she, in fact, did have that condition. Ultimately this will be a battle of the experts."

Not guilty pleas were entered on Lindsay Clancy’s behalf for the deaths of her infant son Callan; her daughter Cora; and 3-year-old son Dawson.

Judge John A. Canavan III ordered her to remain at a Boston hospital until she is medically cleared to be moved to another facility. Another court hearing is scheduled in May.

Police say Patrick Clancy called 911 on Jan. 24 to report that his wife had tried to kill herself and jumped from a second floor window. When emergency responders arrived, police say, Patrick Clancy went into the house to look for the children and found them strangled in the basement.

David Meier, Patrick Clancy's attorney, attended Tuesday's arraignment and asked the media to respect his client's privacy.

"Patrick Clancy adored his children and was devoted to his wife," he said in an emailed statement. "He did everything he humanly could to support them both and to save his wife from her struggles. The facts that led to this unimaginable tragedy will speak the truth."

Several letters supporting Lindsay Clancy were submitted to the court, many from colleagues and former patients at Massachusetts General Hospital, where Clancy worked as a labor and delivery nurse.

"I am heartbroken that this beautiful young woman, her loving husband and their precious children have been destroyed because they were not provided with the essential medical care that they deserved," wrote nurse Stacey Kabat. "Please know that if our Lindsay had proper treatment this family would still be together."

Other friends of Lindsay Clancy and a group of mothers from southeastern Massachusetts also urged the court to help the Clancy family and said her case should focus more attention on the problem of treating postpartum depression.

"As mothers we know Lindsay was not in a healthy space to carry out the acts she is accused of," wrote a group of dozens of mothers from Foxboro, Mansfield and North Attleboro. "We want to stand by her in her darkest hour, as we wish any other mother would do for us if we found ourselves struggling too.

Resources: You can reach the National Suicide Prevention Lifeline at 988 and the Samaritans Statewide Hotline (call or text) at 1-877-870-HOPE (4673). Call2Talk can be accessed by calling Massachusetts 211 or 508-532-2255 (or text c2t to 741741).