LIVE UPDATES: On Day 9 of Lindsay Clancy trial, jury hears from first psychiatrist who treated Lindsay

Lindsay Clancy’s murder trial is underway in Massachusetts. The 35-year-old woman is charged with three counts of murder for the strangling deaths of her three children, ages 5, 3, and 8 months old. Clancy is present in the courtroom, bound to a wheelchair after she was paralyzed by injuries she sustained when she jumped from her home’s second-story window in an alleged suicide attempt. Her defense lawyer claims she was insane at the time, suffering from postpartum psychosis, and could not appreciate the wrongfulness of her actions. We are posting live updates from the courtroom here. Time notes are Eastern Daylight Time. Please forgive typos.

3:48 p.m. Judge is excusing the jury for the day. Court is in recess until Monday at 9:00 a.m.

3:41 p.m. January 23, 2023 – she was doing alright, she was on 2mg of valium, mood was the same, flat anxious. Forced herself to get out of bed. sleeping ok. She did not report any suicidal or homicidal ideation. No changes in her speech patterns. Insight poor? During the 14 visits – she was over attributing her depression to medication. Mental status on 23, speech, appropriate, dressed appropriate. Continue the same dose of Diazapam, increased the amitriptyline. Did she ever say she was planning to kill herself and her children? ‘absolutely not’ **Did she give you any reason to file a section 12. No. Best response is a combination of medication and therapy.
Judge calls for a sidebar.

3:38 p.m. January 16, 2023 – STill depressed mood was low, she could take care of basics, hygiene and took care of baby. She felt bonding was forced with the baby. Discuss valium taper – she did not want to take a benzo every day for sleep discussed how to get off of that medication safely. At this point decided to try the amitriptyline, and started her with the lowest dose. Medications have side effects, lower the dose the milder the side effects. Mood and affect were depressed. NO reason to seek a section 12.

3:32 p.m. January 9, 2023 – Increased Trazodone was helpful. Mood – was ok still feeling flat. Not able to cry able to laugh. Did not have recent thoughts of suicide, or homicidal thoughts. She had been off of the Seroquel for several weeks. She was not getting better – felt that we needed to treat depression considered wellbutrin. Why no decision? She had rebound anxiety with ativan. Decided to switch to diazapam. Easier to stop. Did she email you on Jan 11 about ketamine therapy? It’s a great option, hard to get insurance to cover, need to try 4 other medications first. She tell you she’s depressed. She is getting desperate wanting something to work quickly? . Did you ever recommend ketamine therapy. Something i considered. She had been treatment resistant.

3:29 p.m. Saw Lindsay January 6, 2023 – She had just been discharged from McLean hospital. She continued to feel depressed, attributed it to the seroquel. What was she prescribed at that time. Traz 100 mg. ativan and melatonin. She reported no suicidal or homcidal ideation. Her mood and affect were congruent. Plan was to increase trazadone. She had just come off the Seroquel. She was going to continue with ativan and the melatonin – yes. Witness noted ‘deteriorating.’
She wasn’t improving, not unchanged, she was a little worse than the last time. Was she in imminent danger of harming herself. No. Did not feel she was at risk of harming herself or anyone else.

3:19 p.m. Next saw Lindsay Dec. 16, 2022 – Lindsay reported not feeling well having a hard time. Feeling very depressed, had some SI went to MAss General ER. Feeling hopeless but did not have suicidal plans. She described a feeling of hopelessness, and a fear of not getting better. She did not have a plan to kill herself.
She said she was taking mixture of valium and quetiapine. She mentioned part hospitalization program in Rhode Island thought it was a good fit. Prescribed Lamictal for her. Lindsay continued with the seroquel as prescribed by the SS hospital. Did you communicate with SS about adding another prescription.

3:12 p.m. I advised that she have one person to manage the medication. Ativan and Klonopin effective work fast. Depression medication take a while to kick in. Takes time for changes to happen. She did not meet the criteria for bipolar. Did not have days of euphoria or fast speech. Her behavior did not indicate mania. Plan was to see doctors at South Shore. She had appt with them. Considering taking Seroquel without the Remeron. Discussed a Lamictal (another medication) and a partial hospitalization program. She was having a hard time. Referred her to the HRI hosptial program.

3:04 p.m. Next appoint Nov 22/22. Clancy started South Shore perinatal mental health clinic. She reported she would start Prozac. She was using ativan and benadryl. Had she reduced the dose of Ativan. Denied suicidal and homicidal ideation and showed no signs of psychosis. Plan was to transfer care to SS peri-natal clinic. Gave her a return to work letter. Don’t remember the date to return to work – not immediate. Lindsay scheduled an appt with her on Dec. 1, 2022. Told her that she was not returning to work. Discussed she was not getting better. tried to taper ativan. Without ativan – insomnia. She was having trouble withthe other medications. Tried Trazodone, Prozac didn’t help. Tried Remeron no help. Hadn’t started Seroquel.
Trazodone – 50 mg meant for sleep. Prozac worsened her sleep. Remeron another anti-depressant. Told her she was having intrusive thoughts – feeling like she was going to die. She denied having suicidal ideation – felt badly – close to having suicidal thoughts, and feeling hopeless, no plan.

2:58 p.m. Clancy had a therapy appointment on Oct. 31, and a Nov 2 appt with Dr. Tufts. She did not start it – because she was too afraid. She continued with the Ativan. Did not discuss the hydroxyzine. Affect that day was appropropriate. Mood was normal. She reported no homicidal or suicidal ideation or symptoms of psychosis. Discussion about ativan – risk of dependency. Alternatives included Remeron help her with sleep, don’t have risk of dependency. No change in her mental status. Discussed tapering the ativan, by .25 mg. every two weeks.

2:47 p.m. Contd. direct of Tufts: Suggested alternative to medication – supplements. She was reluctant to start another medication. She said she was not having hallucinations, and denied having suicidal or homicidal ideation on her October 21. Affect was depressed. No changes in her speech or mental status exam. All appointments were virtual.
Plan after this appt, she start ativan as needed. Take the medication when symptoms of anxiety are severe. Lowest dose of ativan she prescribed was .5. Recommended for one week, and follow up in one week. Saw her again on October 26/22. Affect was depressed. Mood was anxious and depressed. She said Ativan was not helpful for sleep but made her less anxious.
She reported taking over-the-counter Benadryl, which helped. Did not have suicidal or homicidal thoughts, and exhibited no symptoms of psychosis. Recommended Buspar – new medication .5mg twice a day and hydroxyzine to take instead of Benadryl.

2:39 p.m. In therapy notes Lindsay disclosed she had supportive parents, and an older sister. But did not rely on her inlaws to help with the children did not have a particular reason. During their 4th visit October 20- Lindsay reported that after taking Zoloft for a week, she had insomnia, diarrhea, feeling anxious and foggy. Lindsay expressed some reluctance to try something new, she did not want to start a new medication. She reported no suicidal or homicidal thoughts, and did not exhibit symptoms of psychosis. Affect was depressed. Mood was depressed and anxious. Expressed concern that she was having suicidal thoughts. She had appt on Oct 21, a day later because she had bad experience with Zoloft.

2:28 p.m. Contd. direct of Dr. Tufts:patient appointments are 25 minutes. 17 minutes is the talk time – the balance of the appt is to discuss medication. What was the plan going forward. At this point – she was improving. Pause on the medication question and meet with one of the therapists. Clancy was receptive to the plan. October 3, next appointment based on her request. Requested paper work to extend maternity leave, which she filled out. Note from Lindsay – ‘I don’t feel mentally well enough to return to work… Can I send you the form to fill out.’
Recalled on October 3rd appointment, they jointly decided to extend her maternity leave with a proposed return on Jan 1. She was feeling that medication might be helpful.

2:18 p.m. Contd direct: Prosecutor: What was the treatment plan?
A: To start zoloft, individual therapy, and follow up with doctor.
Did you go over alternatives? Alternative was to not take the medication which she did before. Did she understand the plan? yes. Clancy had informed consent to everything you discussed? Yes. AT next appointment Sept 28, 2022, she said she decided not to take it. She said she felt a little bit better. Baby was getting more sleep and that helped her feel better. Gave her a mental status exam on Sept 28. Lindsay was alert, dressed appropriately, not depressed, normal mood. Affect was full. Speech and thought content appropriate. Did not mention hallucination. Insight was poor, judgement was excellent. Insight note- she had significant anxiety – but did not want to take the medication. No lab work ordered because it wasn’t necessary. No blood work ordered for generalized anxiety disorder.

2:14 p.m. Cont. Direct: Tufts noted ‘Zoloft one week nervous about breast feeding’ – She said Lindsay had tried zoloft after the 2nd baby. What were the side effects she reported? Don’t remember but they did not seem concerning. In the first couple of weeks of treatment might have diareha, difficult with appetite, nausea. ‘Feeling overwhelmed, baby needed more attention. worries about baby not eating and sleeping won’t take the bottle. Denied audio and visual hallucinations. Suicidal and homicidal ideation, noted ‘no concern about hurting baby.’ Objection. What did she tell you? I asked if there were those thoughts and she denied them.

2:10 p.m. Court is back in session. Prosecutors ask for a sidebar.

1:00 p.m. Jury is excused till 2:00 p.m. Judge warns of serious consequences about inappropriate comments.

12:57 p.m. What was your initial diagnosis, generalized anxiety disorder (worried about a lot of things), adjustment disorder with depressed mood (symptoms of Depression).

12:47 p.m. Based on her observations and questions, Lindsay did not appear to have any issues with memory, judgment. Regarding mood – Lindsay reported she was ‘ok,’ Witness says she appeared anxious. 1st meeting was 50 to 60 minutes during their first virtual meeting. Lindsay reported her biggest concern was anxiety. Treatment recommended Zoloft medication and individual therapy. She was generally reluctant but interested in learning what medications may be helpful.
Recommended zoloft – safest SSRI for babies. Zoloft is a first line medication – recommended first.
Recommended 25 mg for one week, increasing to 50 mg. Took advantage of service started seeing therapist Jennifer McAllister. Treatment goals? Don’t recall what Lindsay said – but goals would be what she says. Goals were ‘symptom reduction and improved functioning.’ Why was she reluctant? She was worried about side effects.

12:38 p.m. Lindsay responded ‘no’ to having thoughts about suicide, homicide, thoughts telling her to hurt herself or others. Asked her if she has ever had a period of time when you were excessive energetic or euphoria. Did any of her answers she had experienced mania or manic episodes. NO. Did not note any signs of psychosis when she saw her.
Asked Lindsay if she had heard voices or seen things others didn’t see – she responded no.

12:24 p.m. Commonwealth Witness #60 Dr. Jennifer Tufts, Psychiatrist licensed for 4 years @ Aster Mental Health:
Treated Lindsay Clancy first saw her Sept. 15, 2022.
Lindsay reported that she had previously taken prozac & wellbutrin in Nursing School. Experienced no side effects.
Reported 1 to 2 drinks at a time 5 times a week and feeling guilty about it.
Initial survey she reported symptoms: anxiety attacks, depressed, easily distracted, guilt, unable to feel pleasure, fall asleep and racing thoughts. The survey lists other symptoms that were not checked.
Suicide assessment risk form was filled out, responded ‘no’ to questions about whether she wanted to end her life. ‘no’ to a specific plan to commit suicide, thoughts of killing or hurting someone, answers to every question on suicide checklist was no.
Lindsay also filled out a forms assessing substance use assessment, DHD report, and Generalized Anxiety Disorder (GAD). On the GAD form she reported feeling anxiety related symptoms “nearly every day.” Lindsay responded to questions on Screening for Depression

12:10 p.m. Cross Goodheart: Postpartum psychosis is a serious consideration- correct. Lindsay was responsive to your advice and she made a follow up appt? yes.
Redirect: Ex. 146 After visit summary for Lindsay? yes. In this paperwork gives instructions; a crisis plan; suicide lifeline; and online resources. She participated in particular groups that would have given her info. yes. Objection – beyond the scope. Would you have preferred more time to assess her symptoms? Had you had the opportunity to observe her symptoms for more than a day or two. Symptoms were resolved? yes. She was sleeping better, mood had improved. Did not get to the root causes of numbness – with more time you could? yes. Suicide hotlines is a point of intervention. They have to identify that they have an intent and plan. Did she ever indicate she had a plan? no.

12:09 p.m. Court is back in session.

11:36 a.m. Judge calls for the morning recess.

11:27 a.m. What if any investigation did you other than what Lindsay and Patrick told you? Did you do blood test? Not a regular procedure at all. McLean did draw blood for substances of abuse but nothing else. Didn’t test her against the EDPS Edinburgh scale – postpartum scale for Depression – used to assess risk factor for postpartum Depression. Not administered to Lindsay- “we don’t administered scales. It is a tool but not determines the diagnosis”

11:17 a.m. Cross Q: Do you use DSM4 – do use for diagnostical purposes? yes. Is Postpartum in the DSM? It’s a sub category of Depression – what about postpartum psychosis? don’t recall. What’s your understanding of cutoff for postpartum, for DSM-5 it’s 4 weeks, CDC 12 months. Are you aware of efforts being made to include post partum psychosis in the DSM-6. I think there is a question about where it is being placed or categorized. Vaguely. What impact does thyroid have? Thyroid can affect one’s mood and anxiety whether pregnant or not. Thyroid levels are important in evaluating when a woman is postpartum? It’s a tiny component. Test can be done. Was it done at McLean? No. In other words it was imported by computer access from MGH years before. Yes. As her treating psychiatrist – what you can do to help her- did you look at the thyroid reads? I would have reviewed the labs – it was within normal reads. NO thyroid test done while she was at McLean? no.

11:02 a.m. Do you know what medication Dr. Tufts prescribed to Lindsay? Zoloft – an antidepressant. Are you supposed to prescribe Zoloft to a person with bipolar? It depends. Lindsay was cooperative and forthcoming. Do you know how many mg. Lindsay stated it was 25 mg. Increased to 50 mg. Appropriate to take history just from patient? I had no reason to believe she wasn’t a reliable reporter. Did you give her MMPI – a test to assess whether someone is lying about their symptoms. Heard of it – not given to her.
Do you know how many times she reached out to suicide hotline? Don’t know. Isn’t that important to know? Lindsay told us she had suicidal thoughts so I know that she struggled with suicide ideation, but she did not have a o plan.

Q: How many women did you treat that suffered from postpartum psychosis? I don’t think i have. I haven’t seen any.
How about postpartum depression? Yes. Over the last 20 years lots of patients. Don’t keep a record.

10:47 a.m. Cross of Goodheart: What were the resources provided to her? She was aware of the website Psychology Today. She was given a case manager and phone number who she could contact for other providers. She had a case manager at Blue Cross Blue Shield -that was a benefit. Other than that what resources were provided? Numerous resources printed on discharge summary. She came in as a voluntary? correct. New Year’s Eve that ward is running on a skeleton crew. You have to ask someone who was there. ABSouth. How many doctors work on a shift? 4 psychiatrists assigned. Nurse assigned to each team (4). Each team has psych, nurse, health worker. Each team works a 7-hour shift. Lindsay received a full psychiatric evaluation (CEC). Can’t say how long the evaluation takes. Social worker talked to Patrick who expressed his concern that she wasn’t getting good medical care. Reddington grills witness about what she knew about Lindsay’s past medical history and treatment.

10:46 a.m. Direct: What did you prescribe? 14 days of Ativan and 14 days of Trazadone. Was she asked if she wanted to kill herself? she denied it. She denied wanting to harm herself or anyone ele.se

10:43 a.m. She never complained that she was not being seen by doctors. Is there a mechanism for a patient to file a complaint. it is posted in the unit. Do they have the ability to request a mental health worker. She continued to engage with groups and mental health workers on January 5. She was discharged around 3ish. She was provided with information about resources that she oculd consult at home. yes.

10:39 p.m. Ctd. Direct of Goodheart: She was future oriented, she’s a caring mother, she had her parents around to help her, and out patient care for follow up, no history of psychosis, post partum psychosis, she had a stable place to live. From Jan to discharge on Jan 5 – no time while at McLean did not report thoughts of harming anyone. She never stated that she had thoughts of harming anybody else. She was able to secure a follow up appointment. Plan was to continue on ativan to help her sleep. Once mood returned to baseline she could come off of it. She had trazadone. Did not give her another prescription for seroquel.

10:32 a.m.Ctd. Direct of Goodheart: Saw Lindsay Jan 3 9:15 am, Lindsay met with a social worker and nurse that day. She participated in a group at 12:02, engaged with a mental health worker at 12:22 pm. Saw a mental health worker before she went to bed at 8:52 p.m. Saw her January 4. She said she slept well the night before. Did you discuss going home. Originally we had talked about discharge on Friday. She said she was anxious being in the hospital. She wanted to be home with family and her children. She asked to leave earlier than Friday. yes. told her she could leave if she had psych follow up the next day. Wanted to ensure that if she wasn’t able to sleep after discharge, so they could come up with a plan so she could sleep and monitor her off of the medication and to assess whether she could think clearly. She was on 75mg of Seroquel 1 and 2nd. Night of the 4th she would be 25 mg. She would not be on any Seroquel on January 4th. She was on Trazadone to help her sleep. Were you concerned that she was leaving with no monitoring while not on Seroquel? No concern her safety.

10:26 a.m. Ctd. Direct of Goodheart: Lindsay wanted to be home for Cora’s birthday party. We were observing symptoms that would indicate Bipolar disorder. People’s mental health is affected if they cannot sleep. Sleep deprivation lead to bipolar episode – hypomanic episode. Considered prescribing Simbalta after Seroquel. Switched from valium to ativan to better manage her anxiety. Lindsay reported that her husband had concerns about being on a benzodiazapene. Observed no signs of psychosis, neither were they observed by the other two psychiatrists who spoke with her.

10:16 a.m. Ctd. Direct of Goodheart: Bipolar was suspected. Lindsay disagreed with the diagnosis. Seroquel is used for other conditions. Seroquel used to address insomnia – yes. Dr. Madva recommended reducing Seroquel and monitoring symptoms. yes. Madva saw her again on Jan 2- and reported sleeping well on lower dose of Seroquel. No reports of delusions. Plan was to continue lower the dosage of Seroquel. Also reviewed nurse notes logged throughout the day of January 1. On Jan 2, she interacted with nurses and Dr. Madva. Jan 3, Goodheart met with Lindsay. Reviewed history with her and assessed her mental status. She was appropriately dressed. Speech normal, Behavior was polite and cooperative. Her mood was anxious. She appeared anxious. Affect was congruent to her mood. She had linear thinking and was goal directed.
What were her main concerns? She did not want to be dependent on anti-psychotic medication to fall asleep. Numbness a common side effect of Seroquel – it can be one of the side effects. Did she have a plan for suicide? no. No plan – she had children and her mother. I continued with the plan to taper off Seroquel and see if she could sleep without Seroquel, observe symptoms and mood.

10:12 a.m. Ctd. Direct of Goodheart: A different psychiatrist Elizabeth Madva saw Lindsay on January 1 @ 12:47 pm. At the time she denied feeling depressed, no suicidal thoughts, but felt numb and anxious. What was the plan? One of the things she complained about was numbness. Madva heard her concern and she was sensitive to many medications. She determined that the numbness was the side effect of the meds – plan was to taper the meds and observe the patient to see if the numbness went away and whether other symptoms would become apparent. She was on Seroquel 100mg/a day; Valium 2 mg;Bendadryl. Do you recall Remeron? past medication.

10:04 a.m. Ali Goodheart direct ctd: Lindsay arrived at McLean in the early morning hours of January 1 via ambulance. Checked in voluntarily at 4:00 AM. Lindsay was evaluated by a staff psychiatrist – found to have no acute medical issues, chief complaint was insomnia. She reported feeling numb? yes, and having side effects of medication? yes.
You reviewed all the notes of this patient? yes. The plan was to do the checks, medications remained the same. How long were the checks for her- every 15 minutes. She was considered a low risk patient. The provisional diagnosis by the admitting psychiatrist was “Major Depressive Disorder severe without psychosis.”

9:43 a.m. Commonwealth Witness #59 Ali Goodheart, Psychiatrist:
Works at the McLean Psychiatric Hospital-in patient psych unit. Patients are referred from the ER. They are admitted involuntarily or voluntarily. Describes team approach to treatment, nurses, social workers, contribute to assessment of the patient. Psychiatrist performs an evaluation to determine which in-patient unit with various levels of checks. Lowest level of patients are checked every 15 minutes with the most serious in patients assigned to a staff member at all times.
10:00 a.m. Reddington has interrupted the testimony suggesting some of this background testimony does not apply to Clancy’s case–irritating the judge. Defense objects. Judge says the witness can continue.

9:33 a.m. Commonwealth Witness #58 Sarah Carney, Patrick Clancy’s Friend:
Attended college with Patrick. Friendly relationship with the Clancy family. Did not notice any changes in Lindsay after her children were born. Lindsay was physically active during her pregnancy with Callan. She recalls Lindsay’s video posts exercising while the children were in the background playing with toys (previously said the kids played with the exercise bands). In the fall of 2022 she noticed that Lindsay was ‘thinner.’ Did not discuss with Lindsay her sleep issues. On the weekend of Jan 22, Clancys were invited to her house for a bonfire. Callan was at home with Lindsay’s parents. Lindsay was quiet but fairly normal. During a conversation lull she asked her how she was doing – she said ‘good.’ Noticed no change in her pattern of speech.
Cross: Has known Lindsay for about 12 years. Described their relationship as ‘social.’ In the fall of 2022 how many times did you see Lindsay – one time at drop off. Lindsay was helpful when she asked her for advice. Bonfire was around lunch time. They were there for about 2 hours. Agreed that they were not so close that Lindsay would confide in her.

9:21 a.m. Commonwealth Witness #57 Kimberlee Hardy, Formerly Child Services Director @ Kingsberry Club:
Parents can drop off a child for 2 hours while they use the club’s programs. Patrick mainly did the dropping and picking up of Cora and Dawson Clancy. Fall to winter of 2022 – when she did interact with Lindsay – she seemed shy, not much conversation with her. Told Lindsay that she could bring Callan over – but she didn’t because it was cold and flu season and Lindsay said she was concerned about Callan catching a cold. She was never late picking up Cora and Dawson. Last time she saw Lindsay was a few weeks into January. Last time the kids were at the club was January 19 – when Lindsay dropped them off usually in the morning. Last time she saw Cora – she drew a picture and left it with her.
Cross: Lindsay was never angry – always picked them up on time and they were excited to see her. Not close enough to her to know about her mind. Common advice from psychiatrist is to exercise.

9:20 a.m. Judge advises jury that he expects a full day of testimony today.

9:19 a.m. Case is called. Judge queries the jury.

9:16 a.m. Court is in session. Judge has summoned the attorneys to sidebar.

8:52 a.m. Judge is expected to rule this morning on Defense motion to call experts to counter Commonwealth’s evidence about the psychiatric care that Lindsay received and that her attempt at suicide was not serious.