Lindsay Clancy’s murder trial has focused attention on the medications she received before killing her three children. But the more important question may be what her treatment reveals about a mental-health system trying to manage a deteriorating patient one prescription at a time.
By the time Lindsay Clancy sat down with her psychiatrist on Jan. 23, 2023, her mental-health treatment had become extraordinarily complicated.
Four months earlier, Clancy had been hesitant to take even one psychiatric medication. Since then, she had moved among outpatient providers, an emergency department, a specialized perinatal behavioral-health program, a Rhode Island day program and an inpatient psychiatric hospital. She had been prescribed antidepressants, benzodiazepines, sleep medications, an antipsychotic and a mood stabilizer as clinicians tried to address insomnia, anxiety, depression, intrusive thoughts and suicidal ideation.
The Jan. 23 appointment with psychiatrist Dr. Jennifer Tufts reportedly lasted 17 minutes.
One day later, Clancy strangled her three children — Cora, Dawson and Callan — before jumping from a second-story window in an apparent suicide attempt that left her permanently paralyzed.
Her criminal responsibility is now being fought over through competing psychiatrists, psychologists and attorneys. The defense says Clancy was suffering from severe postpartum psychosis and was legally insane. Prosecutors contend that, while seriously mentally ill, she remained capable of understanding what she was doing. Experts themselves disagree over whether she suffered from major depression, bipolar disorder or psychosis.
But another question has emerged from the medical history presented around the case.
Who was managing Lindsay Clancy’s treatment as a whole?
And beyond Clancy herself: when a psychiatric patient keeps getting worse while medications are added, stopped, restarted and changed across several providers, at what point does the medical system stop asking which medication to try next and begin asking whether the treatment process itself is failing?
Much of the public conversation surrounding Clancy has centered on one startling figure: 13 psychiatric medications.
That number requires context.
The evidence summarized through the litigation does not show Clancy simultaneously taking 13 psychiatric drugs when she killed her children. Rather, at least 13 medications appear across approximately four months of treatment as prescriptions were started, discontinued, substituted or restarted.
Toxicologist Justin Brower testified that blood collected after the killings contained four psychiatric medications: mirtazapine, lamotrigine, trazodone and quetiapine — better known by some of their brand names as Remeron, Lamictal and Seroquel.
Brower reportedly testified that the levels did not indicate a deliberate overdose, although quetiapine was slightly elevated.
That distinction matters.
“Thirteen medications” makes for an alarming headline. It can also produce an image of a patient swallowing 13 different psychiatric drugs every morning.
That is not what the available evidence establishes.
But correcting that misconception does not make Clancy’s medication history unremarkable.
It makes the underlying question more interesting.
Over a relatively short period, clinicians repeatedly changed the pharmacological approach to a woman whose psychiatric condition was becoming more serious.
The issue is not simply how many pills were in her bloodstream on Jan. 24.
It is what happened during the months that got her there.
One medication becomes another
Clancy gave birth to her third child in May 2022.
By August, according to allegations contained in subsequent civil litigation, she was experiencing severe anxiety and insomnia as she prepared to return to work as a labor and delivery nurse. On Sept. 12, she scored 23 out of 30 on the Edinburgh Postnatal Depression Scale, indicating substantial distress. Three days later, Tufts diagnosed generalized anxiety disorder and adjustment disorder with depressed mood and prescribed 25 milligrams of sertraline, commonly sold as Zoloft.
Clancy reportedly resisted taking it at first.
When she eventually did, the dose was increased to 50 milligrams.
On Oct. 20, she reported racing thoughts, severe insomnia, mental fog and fears surrounding suicidal thoughts. The civil litigation alleges she went roughly 48 hours without sleeping after the dosage increase. Tufts discontinued sertraline and prescribed lorazepam — Ativan — for anxiety and diphenhydramine for sleep.
November brought more interventions.
Clancy went to South Shore Hospital’s emergency department with severe insomnia and received trazodone. A psychiatric consultation the following day reportedly raised the possibility that her reaction to sertraline could point toward an underlying bipolar disorder.
Days later, another provider prescribed another SSRI antidepressant: fluoxetine, or Prozac.
Then came zolpidem, better known as Ambien; mirtazapine, or Remeron; and clonazepam, or Klonopin. Clancy subsequently reported disorientation, forgetfulness, panic and feeling disconnected from her body.
By Nov. 29, she had begun treatment through South Shore’s Perinatal Behavioral Health Program. Rebecca Jollotta, a nurse practitioner there, prescribed quetiapine, or Seroquel, the next day.
Clancy told her mother-in-law that she was terrified of taking additional medication and believed the medication had made her more depressed.
December brought diazepam, or Valium. Lamotrigine, commonly used as a mood stabilizer, was later introduced.
Meanwhile, Clancy was reporting intrusive thoughts and suicidal ideation.
This is where the medication count alone becomes an inadequate way of understanding what happened.
A medication can be entirely reasonable in one patient and inappropriate in another. A drug can be correctly prescribed and still fail. A physician can make a defensible decision with the information available at one appointment while another clinician, possessing different information a week later, makes a different decision.
Medicine is not practiced with the benefit of hindsight.
The more difficult question is whether anyone possessed all of the information at once.
The treatment history described in court and civil filings includes at least several separate points of care.
Tufts treated Clancy through Aster Mental Health.
Jollotta treated her through South Shore’s perinatal program.
Nurse practitioner Julie Paul prescribed several medications during a short period in November.
South Shore Hospital’s emergency department treated her insomnia.
Women & Infants Hospital in Rhode Island later evaluated her through a day program.
Then, on Dec. 31, Clancy voluntarily admitted herself to McLean Hospital for inpatient psychiatric treatment. She left Jan. 5.
Moving between providers is not inherently evidence of poor care. Psychiatric emergencies frequently require different levels of treatment, and hospitals, specialists and outpatient clinicians necessarily perform different roles.
What matters is what followed the patient between those settings.
According to the dossier of testimony and litigation records reviewed by The Directory, Jollotta testified that she never communicated directly with Tufts and did not access Tufts’ medical records, despite both clinicians being involved in Clancy’s treatment.
The same record indicates Jollotta did not speak with clinicians at Women & Infants Hospital. It also says she did not have access to McLean Hospital’s discharge records or treatment plan following Clancy’s inpatient psychiatric admission.
Those facts, if borne out by the underlying testimony and records, deserve attention independently of the murder trial.
Because by this point the question is no longer merely:
Was each medication appropriate?
It is:
Who was responsible for knowing what everybody else had prescribed, observed, stopped, suspected or diagnosed?
Patrick Clancy’s civil litigation alleges that this fragmented treatment and lack of coordination amounted to medical malpractice and contributed to his wife’s deterioration. Those allegations have not been adjudicated, and The Directory cannot conclude from the available record that any provider violated the medical standard of care.
But the distinction between an allegation and a legitimate question matters.
A court may ultimately find no malpractice at all.
It would still be reasonable to ask how a psychiatric patient could pass through that many points of care during an acute crisis without one clinician necessarily possessing a complete picture of the others’ work.
When prescribing becomes polypharmacy
“Polypharmacy” is one of those medical words that sounds like a diagnosis but often describes a circumstance.
A person is taking multiple medications.
That fact alone does not mean the medications are unnecessary, dangerous or improperly prescribed.
For patients with complicated psychiatric illnesses, several medications may serve different purposes. One might stabilize mood. Another might address severe insomnia. Another might treat anxiety. Another could be temporarily used while a longer-term medication takes effect.
The problem is that more medications also create more variables.
Which symptom belongs to the underlying illness?
Which symptom is an adverse effect?
Is a new complaint evidence that the original diagnosis was incomplete?
Is it withdrawal from a medication being stopped?
Is another medication masking the side effect of the first?
Is the patient’s condition deteriorating despite treatment — or because treatment itself needs to be reconsidered?
Clancy’s treatment history illustrates how quickly those questions can compound.
The record describes an apparent severe reaction after her sertraline dose increased. A clinician later documented concern about possible bipolar disorder. Yet Clancy subsequently received another SSRI, fluoxetine. Later treatment incorporated benzodiazepines, sedating antidepressants, an antipsychotic and a mood stabilizer.
That does not establish that those decisions were medically inappropriate.
It does establish why psychiatric prescribing cannot be understood simply by counting prescriptions.
The relevant question is whether each new intervention was part of a coherent treatment strategy — and whether somebody was continually reevaluating the strategy as the patient’s symptoms changed.
There is another complication.
Experts still disagree about what was actually wrong with Lindsay Clancy.
That disagreement is central to the criminal case.
Defense expert Dr. Phillip Resnick concluded Clancy was psychotic at the time of the killings and suffering from delusions and command hallucinations. Defense psychologist Dr. Paul Zeizel similarly concluded she could neither appreciate the wrongfulness of the acts nor conform her behavior to the law.
The prosecution’s experts see something different.
Dr. Avram Mack reportedly found no evidence of mania, hypomania or psychosis leading up to the deaths, instead diagnosing major depression and anxiety. Dr. Kirk Heilbrun concluded Clancy had bipolar II disorder but nevertheless was not acutely psychotic and remained criminally responsible.
That disagreement demonstrates why retrospective diagnosis from outside a courtroom is dangerous.
Postpartum depression, postpartum anxiety, intrusive thoughts associated with obsessive-compulsive symptoms, bipolar illness and postpartum psychosis are not interchangeable labels for a distressed new mother.
They can require substantially different approaches.
The distinction can also be extraordinarily difficult in real time.
Intrusive thoughts, for example, do not automatically mean someone wants to act on them. A patient can be horrified by an unwanted thought precisely because it conflicts with everything she wants or believes.
Psychosis is different. Reality itself may become distorted.
Clancy reportedly disclosed intrusive thoughts in early December. Her providers’ interpretation of those symptoms — and whether they represented severe anxiety or something more dangerous — has since become part of the dispute surrounding her care.
This is one reason the broader conversation about psychiatric prescribing cannot simply become “doctors prescribe too many pills.”
Doctors also face the opposite danger: failing to treat severe mental illness aggressively enough.
The difficult question is how medicine recognizes when a reasonable treatment is not working — and how quickly it changes course when the patient’s diagnosis itself may be changing.
The easiest intervention may not be the complete intervention
There is a broader mental-health question buried underneath Clancy’s case.
Medication is tangible.
A clinician can identify a symptom, select a drug, determine a dose and schedule a follow-up. If the medication fails, the dose may change or another medication may be substituted.
But severe psychiatric illness does not exist only in a prescription bottle.
It can require psychotherapy, intensive outpatient treatment, specialist psychiatry, close monitoring, family involvement, hospitalization and — perhaps most importantly — continuity between each of those pieces.
Clancy eventually received several of those higher levels of care.
She attended a specialized perinatal program. She entered a day program. She voluntarily checked herself into McLean Hospital.
That makes the communication question even more significant.
An inpatient psychiatric admission should produce information.
What was observed around the clock?
What diagnosis was considered?
Which medications were stopped?
Which were continued?
What changed?
What did the hospital believe the outpatient clinician needed to watch next?
The dossier identifies McLean’s precise discharge summary and transition-of-care plan as among the records that remain unavailable in the public record reviewed for this reporting. It similarly identifies missing detail from Clancy’s Jan. 23 appointment with Tufts.
Without those records, it would be irresponsible to declare that the transition failed.
But their importance demonstrates something larger:
Psychiatric care is not merely the collection of individual appointments.
The handoffs matter, too.
What does “overprescribed” actually mean?
The word will inevitably follow this case.
It already has.
But it deserves a more demanding definition than “a lot of medications.”
If five medications are clinically necessary, prescribing five is not overprescribing.
If one medication is unnecessary or harmful, prescribing one can be too many.
And a long medication history does not necessarily mean a patient was heavily medicated at one moment.
Clancy’s toxicology is the clearest example. Four psychiatric medications were detected after the killings, not 13.
The real investigation into overprescribing therefore has to ask different questions.
Was there a clear indication for each medication?
Were expected benefits and risks documented?
How quickly were drugs changed?
Were prior adverse reactions considered before another drug in the same class was attempted?
Were medications intended to be taken together or were old prescriptions simply still appearing on a historical medication list?
Was somebody reconciling that list?
Were symptoms monitored after changes?
And when a patient repeatedly said she was getting worse, how did clinicians determine whether they were seeing the progression of an underlying disease or the effects of treatment?
Those are questions for independent psychiatrists, psychiatric pharmacists and specialists in perinatal mental health — not conclusions a newspaper should manufacture from a medication list.
They are also questions that matter to considerably more people than those following a murder trial.
Any serious discussion of psychiatric overprescribing also has to resist an easy ideological trap.
America can have a problem with too much medication in some circumstances while simultaneously having a problem with far too little mental-health care.
Those are not contradictory propositions.
A patient can receive several prescriptions and still struggle to obtain prolonged access to a psychiatrist.
A community can spend enormous sums treating psychiatric crises in emergency departments while lacking enough outpatient specialists.
A patient can technically have “care” from several institutions and still lack continuity between them.
The measure of a mental-health system cannot simply be whether someone was prescribed something.
It has to be whether the patient was actually being managed.
Clancy sought help repeatedly.
Whatever ultimately explains her mental state on Jan. 24, the record does not describe a woman completely outside the health-care system. She was inside it — repeatedly seeing clinicians, visiting hospitals, entering specialized programs and eventually admitting herself for inpatient psychiatric treatment.
That may be the most disturbing systemic question raised by the case.
What does it mean when a person can be receiving that much mental-health care and still be deteriorating?
What the medications cannot tell us
There is a temptation, particularly in a case this horrific, to search backward until something provides an explanation proportionate to the outcome.
Thirteen medications.
Postpartum psychosis.
Bipolar disorder.
A failed hospital discharge.
An adverse drug reaction.
One of those can become the thing that makes an incomprehensible crime feel comprehensible.
The evidence does not permit that certainty.
There is no basis in the material reviewed by The Directory to say that one medication caused Lindsay Clancy to kill her children.
There is no basis to independently diagnose her.
There is no basis to conclude that her doctors committed malpractice.
And there is no basis to describe her as being intoxicated by 13 medications on Jan. 24. The toxicology evidence directly contradicts that characterization.
The criminal trial has presented highly credentialed experts who cannot even agree on Clancy’s underlying diagnosis, much less what was happening inside her mind during the killings.
A jury will be asked to resolve the legal question.
Medicine has a different question to answer.
Lindsay Clancy’s case is extraordinary because of what happened at the end of it.
The treatment questions it raises are not.
People experiencing psychiatric crises frequently move between primary-care offices, psychiatrists, therapists, emergency departments, inpatient hospitals and pharmacies. Their medications change. Providers change. Diagnoses evolve. Records do not always arrive at the same time the patient does.
Most of those stories do not end with three dead children.
That is precisely why the broader questions should not disappear when Clancy’s trial ends.
The measure of good psychiatric care cannot be whether every medication ultimately worked. Psychiatry, like the rest of medicine, involves uncertainty, failed treatments and difficult judgment calls.
Nor should an unsuccessful medication automatically be treated as evidence that prescribing it was a mistake.
The more useful standard is whether the system remained capable of seeing the patient as a whole while individual clinicians treated pieces of the problem.
Because every prescription can make sense by itself.
Every appointment can make sense by itself.
Every referral can make sense by itself.
And still, when assembled together, something can be going terribly wrong.
That is the question Lindsay Clancy’s treatment history leaves behind.
Not simply why she was prescribed so many medications.
But who was responsible for recognizing when adding another prescription was no longer enough.