Lindsay Clancy & the 13 Medications Prescribed to Her: 48 Hours of No Sleep After New Med

If you ever feel the urge to occupy yourself entirely with learning about the directionality of stroller wheels, is it an all-wheel-drive baby stroller? There’s dense literature on Reddit parenting forums. You’ll come out more educated on strollers, and equally confused about which one to buy. But that’s surface-level content. It gets much deeper. You might stumble on posts asking whether it’s normal to hear cries that aren’t really there in the middle of the night: phantom cries. They used to call it “insanity of lactation.” Now it’s postpartum psychosis, a rare, severe condition distinct from postpartum depression. Postpartum depression is more common, affecting about one in eight people who give birth. Postpartum psychosis affects roughly one to two per 1,000 births. Depression can mean persistent sadness, anxiety, and exhaustion. Psychosis can involve hallucinations, delusions, and disorganized behavior, and it can be intermittent, hidden behind long lucid periods. That distinction has become central to the question surrounding Lindsay Clancy: did she have postpartum psychosis, or didn’t she? Full show notes available at RottenMangoPodcast.com

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  If you ever find the urge to occupy yourself entirely with learning about the directionality of strollers and the stroller wheels, is it an all-wheel baby stroller? There is dense literature to be read on Reddit forums about parenting and baby strollers. You will come out more educated on strollers and stroller wheels, but also equally confused on which exact stroller you should get for your new baby. But that is the surface level content on these parenting forums. It does in fact get much deeper. Because you could always stumble upon a post asking, is it normal to hear cries that aren't really there in the middle of the night? Like phantom cries. They used to call it insanity of lactation. Postpartum psychosis is not like a new, modern day language.

• 2:16Speaker 01

  It's not a modern day thing. Back in the day, they said it was insanity of lactation. Postpartum psychosis, however, I will say, is not the same thing as postpartum depression. Postpartum depression is quite common. One in eight people who give birth experience it. While postpartum psychosis, it's pretty rare, about one to two people per 1,000 births. And that's kind of a distinction that's been lost in this case. Where maybe, hopefully, very well-intended commentators out there of other mothers or other parents who are saying things like, well, I had postpartum depression really bad, and I would never harm my children. I don't know if it's necessarily helpful or productive, or perhaps even accurate input at this point.

• 3:00Speaker 01

  Postpartum depression and postpartum psychosis are completely different beasts, just very different. If you take the word "postpartum" out of it, it's like someone with depression saying that they never heard a voice that wasn't ever there. It's like, okay, well, that makes sense. And one would also imagine, because they're so different, that no one could ever mistake postpartum psychosis as postpartum depression. But that's not the case. Because people with postpartum psychosis also do have symptoms of postpartum depression. And from the outside, it could look like they just have postpartum depression, but the psychotic part is usually intermittent and hidden. Hidden meaning, it only presents itself for perhaps a small window. Patients can have prolonged lucid periods where they are not really in a state of psychosis.

• 3:45Speaker 01

  And to, I mean, what are the odds that that times up when you see a provider? When you're talking to your therapist or your psychiatrist? There's also no standardized tool to capture postpartum psychosis. There's standardized tools to capture postpartum anxiety and depression, but not psychosis. One person on Reddit years ago writes, "I spent a lot of time scouring the internet for PPP, postpartum psychosis stories that match my own. I don't fall into the category of the most typical presentation of it." So, a lot of times, people will hallucinate that, there's a lot of like religious hallucinations that the devil is coming for their baby. One mom wrote, "They believed that their husband was the second coming of Christ."

• 4:31Speaker 01

  And the only way for that prophecy to be fulfilled was if their child died. But it would be okay because the husband would bring the child back. And then they were saying like, a lot of the things that they were seeing online just kind of fed into this like second coming narrative. Now, some of these people are not even that religious before they entered into postpartum psychosis, but she says, "I didn't hallucinate that the devil was coming for my baby. I didn't even hallucinate that my husband wanted to kidnap him." Which is another common thing, is like someone wants to kidnap your baby, and you're the only one that can protect them. She says, "It was more subtle, like something growing in my lungs.

• 5:12Speaker 01

  I knew I couldn't breathe as easily, but I adapted as I went because I couldn't quite identify what was wrong. I lost myself, I fell into a deep depression." She says, "Once that depression hit, the intrusive, like weird thoughts started coming." She says, "It started off just as thoughts, intrusive, scary thoughts." So, this is where it gets even more confusing. When she says that she falls into a deep depression. When she sees a psychiatrist, that could present itself clinically as just postpartum depression. Then she starts having intrusive thoughts. There's also something called postpartum OCD. Where it is someone who just gave birth, and a lot of these people, they have a hard time even coming to providers for it

• 5:56Speaker 01

  because they're scared their baby's gonna be taken away. There is one woman who says that she had to, every time she went up and down the stairs, she had to sit on her butt and scoot from one step at a time. Because she had this intrusive visual that she would chuck her baby down the stairs. She didn't want to chuck her baby down the stairs. But she's almost like, why do I keep thinking this thought unless I secretly must want it? Which is actually a huge thing with people who have regular OCD, not postpartum OCD. They think their intrusive thoughts are some sort of reflection of their deepest wants and desires. But she, that was her postpartum version of it. So, she's like, "If I don't want to actually chuck my baby down the stairs, why do I keep thinking about chucking my baby down the stairs?" There's also a lot of people with postpartum OCD that are too scared to report this to their providers,

• 6:41Speaker 01

  but they say that they couldn't even change their kid's diapers because they kept having an intrusive thought of assaying their own child. And they would never, but that is literally what OCD is. I know a lot of people online think OCD is like, I gotta tap my foot five times. I gotta make sure the stove is off six times. But a lot of OCD are just like really intrusive thoughts that are like compulsion. You can't stop it. So then she's having these intrusive thoughts. So like, this is, it's just, the clinical presentation is very confusing. So she goes from feeling depressed to all these intrusive thoughts. And she thought it was nothing more than that, but then they started growing. So she moves out of the intrusive thoughts. She says, "While playing peekaboo,

• 7:23Speaker 01

  I would leave the blanket over his face just a little longer than necessary. I would think more and more about how if I couldn't even take care of him, no one else could either. I dangerously kept quiet about all these thoughts. I previously had passive thoughts wishing I would get hit by a car and require hospitalization just so I could escape. I needed to escape this never-ending cycle of sleep deprivation, crying from me and the baby, and isolation. But those thoughts eventually turned into plans of how I could self-exit. I weighed my options. I, I mean, I clearly wasn't right. I couldn't put it into any other words. I felt wrong, I felt broken, but I didn't know how to articulate it or ask for help. If I was honest, I was really scared that someone would take my baby away from me. But then things got worse and they got worse really fast.

• 8:09Speaker 01

  She does ask for help, she gets put on Zoloft, and it doesn't matter, because a month later, she's taken to a psychiatric hospital for a week after a self-exit attempt. And from reading one too many forums about postpartum psychosis, a lot of people who have experienced it say, "They presented primarily with symptoms of depression and anxiety. And the people around them saw symptoms of depression and anxiety." Now, that's not to say that having postpartum psychosis makes one harm their child, nor does it mean that Lindsay Clancy herself had postpartum psychosis. All this means is there's a big debate. And this debate is not black and white. And this debate is not, oh, take her blood, see if she has something in her system.

• 8:53Speaker 01

  It's a huge debate of, did she or did she not have postpartum psychosis? And that question is going to be life in prison or not. And it's going to play a very big role in her trial and her potential new upcoming trial, if there is one. This is the case of Lindsay Clancy.

• 9:32Speaker 01

  We would like to thank today's sponsors who have made it possible for Rotten Mango to support Postpartum Support International. Their mission is dedicated to promoting awareness, prevention, and treatment of mental health issues related to childbearing in every country worldwide. This episode's partnerships have also made it possible to support Rotten Mango's team of dedicated researchers, and we'd also like to thank you guys for your continued support. As always, full show notes available at rottenmangopodcast.com. This case has a lot of heavy themes of mental health conditions like postpartum depression, psychosis, bipolar disorder. However, the details of this case are not representative of these particular diagnoses, and no generalization should be made from this case about those conditions. There are mentions of taking one's life, as well as the lives of others, particularly

• 10:17Speaker 01

  children and infants. We may mention various opinions, speculations, comments, all from the public about this case and those involved. These are not representative of our own, or are they legally confirmed? Everything available for this case that we pulled from is public information, so keep that in mind, and statements, quotes, may be summarized, condensed, or shortened for brevity. This is going to be a multi-part series. There is a lot of ground to cover, and before we even get into the whole Patrick Clancy and Rachel Dannis's 60 Minutes interview, which is going to be in the next part, before we get into all of that, I feel like there is, there is some necessary groundwork that needs to be laid for the legal aspect of this case, the postpartum psychosis debate, as well as

• 11:01Speaker 01

  all of the medications that Lindsay Clancy was on at the time, and all of the ways that her prescribers are either under fire or are being praised by people online of whether or not they helped or failed Lindsay. There's just so much before we can even get into Patrick that we're all going to cover in this episode right now. So with that being said, watch with discretion, take care, and let's get into it. It's not impossible to be depressed at a wedding, but hopefully it's not your wedding that you're depressed at. September 17th, 2022. This is four months before the Clancy children are killed. Their parents, Lindsay and Patrick Clancy, are in New Hampshire.

• 11:43Speaker 01

  So they're from Massachusetts, but they're in New Hampshire for a friend's wedding. Their family members are helping take care of the two older children, Cora and Dawson, and they brought along the four-month-old newborn Callan with them. So he's four months old, and they're walking downtown in New Hampshire, and Patrick recalls Lindsay telling him, "I think I'm gonna start taking Zoloft." Zoloft is a very common SSRI. It's an antidepressant. And he says that Lindsay told him, "I think it's really gonna help with anxiety and with going back to work." From the statements made by Patrick, it appears like this is the first time Lindsay ever brought up Zoloft, or at least in this timeframe, since Callan was born, to the point where he was even wondering, like, "Where are you gonna get the Zoloft? What are you talking

• 12:27Speaker 01

  about, right?" He didn't know that by this point, when she's talking to him about Zoloft, she already had the prescription for Zoloft. She got it two days before. But the conversation stands. She hasn't started taking the Zoloft, so technically she is informing him, "I think I'm gonna start taking Zoloft." And she does. Lindsay Clancy starts taking Zoloft about four and a half months after giving birth to their third child, Callan Clancy. Patrick says he doesn't know the exact timeframe that she was on the Zoloft, but she just kept getting worse and worse. There is something called the GAD test. It's the generalized anxiety test. It's got a list of questions for patients to answer. It's pretty straightforward, very easy questions.

• 13:10Speaker 01

  "Do you feel anxious? Do you feel anxious a few times a week, several times a week, most days of the week?" It's not a very thorough test. I mean, it's, it's a screener. So, "Do you feel restless?" Questions like that. And then it spits out this random numerical score, and it's just a screening tool. It's not a diagnostic tool. For feeling nervous, anxious, on edge, Lindsay responds that she feels that nearly every single day. For not being able to stop or control the worrying, she feels that nearly every single day. One of Lindsay's providers later says, "She was significantly high in the GAD7, which is for generalized anxiety. She scored 21 out of 21," which, I mean, they're just screening, so it's not diagnostic, but it did indicate that she was experiencing some extreme anxiety.

• 13:55Speaker 01

  Now, I was on Reddit, and I was like pulling from even my own personal experiences of taking the GAD7 test a few times. I've yet to see many people on even Reddit hitting the 20, 21 mark out of 21. Even at, like, the peak worst I've ever been in was like 17, and that seems to be on par with a lot of Redditors. It's like, a lot of people seem to hit 14, 13, from what I can tell, and then 17, 18 is like, okay, things are not great, but like, I could not find many people who were hitting 21 out of 21. So hitting the ceiling of this GAD7 test, I would imagine, is incredibly concerning. So two days before Lindsay tells Patrick at the wedding that she wants to get on Zoloft,

• 14:37Speaker 01

  she is meeting with a psychiatrist, Dr. Jennifer Tufts. So I'm just gonna give you a quick timeline. September 12th, 2022, Lindsay finds Dr. Tufts online and schedules an appointment. This is really important. So Lindsay looks up, doctors, and she finds Dr. Tufts. I'm assuming that she goes on her website, sees, you know, everything that she's advertising on her page of the things that she specializes in, and then books an appointment with Dr. Tufts.

• 15:02Speaker 02

  Online appointment, right?

• 15:04Speaker 01

  Yeah, it's a telehealth appointment. September 15th, Lindsay has her first telehealth appointment with Tufts. And then September 17th, Lindsay tells Patrick she might want to start Zoloft. Now, she was already prescribed at September 15th, two days before. But back to this very first meeting, Lindsay reports to Dr. Tufts that she feels okay. I mean, okay, right? Dr. Tufts takes notes that Lindsay appeared a little bit anxious, which makes sense, considering that seems to be Lindsay's biggest concern for this appointment, is she just seems to have a lot of anxiety. She just gave birth to their third child in May of 2022. It's now September, so only about like four months. Lindsay's not feeling well. This is peak postpartum period. A lot of people say it's about a year. Some people

• 15:48Speaker 01

  will go as far to say the last two years is the postpartum period, where you gotta look out for postpartum depression and psychosis. But Dr. Tufts prescribes Zoloft. And Lindsay is really hesitant about this, because she remembers that she was prescribed Zoloft when she gave birth to her second child, Dawson, and she just had concerns about breastfeeding while taking the Zoloft. I will say that Zoloft is probably one of the safest medications to breastfeed on, but I think everybody has different standards for safety when it comes to their own children, and that seems to be what applies here. She seems very hesitant, but yet still kind of open to the idea. She even brought it up to Patrick, and eventually,

• 16:29Speaker 01

  two weeks later, she starts taking the Zoloft. So she doesn't take it in September. She gets prescribed it September 15th. She doesn't take it until like mid-October, so actually more than two weeks.

• 16:40Speaker 02

  A month.

• 16:40Speaker 01

  Yeah. The original dose was 25mg, and then it gets increased to 50mg, because it's how it works. You ramp up, and this is not an abnormal dosage for Zoloft. This is nothing concerning in terms of the dose. And once Lindsay hits that 50mg dose, Lindsay hates it. She reports that she has such severe insomnia. She was awake for 48 hours. She had racing thoughts, worsening anxiety, which is like the whole point that she's going on Zoloft. This is just miserable. So she tells this to Dr. Tufts, and they stop the Zoloft.

• 17:24Speaker 03

  I discussed with her and her husband the possibility of potentially an underlying bipolar disorder. I based this on several factors, one of them being that she had such, what we call, an activating response to the Zoloft. It's unusual for somebody to describe taking Zoloft and then going 48 hours without sleep and not being tired.

• 17:55Speaker 01

  There is a huge, very probably meaningful conversation about Lindsay's reaction to Zoloft. A big, bold preface here is, Zoloft is the brand name. The drug is cetolene. Cetolene does not create bipolar disorder.

• 18:10Speaker 02

  Okay.

• 18:12Speaker 01

  But there is an argument that if you take Zoloft or similar SSRIs, it can push someone who already has an underlying bipolar disorder out of depression and straight past what they describe as normal and into a state of hypomania. Some psychiatrists call it the antidepressant-induced mania. And there are lots of anecdotal stories of people saying, like, "Hey, I didn't even know that I was bipolar until I was prescribed Zoloft, because I went into my psychiatrist, and I was showing symptoms of being depressed." So they thought that I had major depression. Then I took Zoloft, then I took all these other SSRIs, and I went into a state of mania, and that's when they're like, "Oh, so actually, your

• 18:55Speaker 01

  diagnosis is not major depression. Your diagnosis is bipolar disorder, typically bipolar disorder 2, right?" The FDA has straight-up stated, "In patients with bipolar disorder, treating a depressive episode with Zoloft or any other antidepressant may precipitate a mixed manic episode." The FDA instructs prescribers to, quote, "Screen patients for any person or family history of bipolar disorder, mania, or hypomania," which hypomania is similar to mania, but instead of the duration being like seven days and needing to be hospitalized, it's at least four consecutive days of very hyperactivity. And hypomania, the scary thing

• 19:38Speaker 01

  for a lot of people is that from the outside, it could appear that you're functioning completely normally when you are in a state of mania. So from the outside perspective, you actually seem like you are functioning better than most people. You might even be more productive. You get four hours of sleep, you're talking fast, you start three new projects, you're running on some sort of high in life. You have this very sure feeling that you can take on everything, but also your attention span is kind of shot, so you're switching between tasks nonstop, but somehow you feel upbeat. You got high energy levels, even if you're not sleeping as much.

• 20:10Speaker 02

  But what happened after that period?

• 20:12Speaker 01

  Usually, it is a very depressed state.

• 20:16Speaker 02

  Right, okay.

• 20:17Speaker 01

  Yeah, and it's very dangerous, because there is really, it doesn't appear that there's a strong guideline for how long these manic states last, and there's different types of mania, and different types of mania can be scary. For one, it's hard for a lot of providers to identify that you're manic when you're in certain states of mania. And then two, it creates like the perfect tornado to usually that could lead to self-exit.

• 20:48Speaker 01

  One person says the same thing happened to them when they took Zoloft. They said it triggered a hypomanic episode at the time and I just thought, wow, these antidepressants work really well for me. And then my psychiatrist switched my misdiagnosis from major depression to bipolar two. There's this one post on the OCD subreddit that reads, I just took Zoloft last night. What the fuck is going on? I woke up at 3:00 AM and I'm wired. Like, I feel incredible. Everyone talks about how SSRIs take forever to kick in. I feel so fucking good. I could probably do anything right now. Like, I feel, I'm kind of jittery and I have so much going on right now. To which all the comments are all warning the OP to tell their psychiatrist because it sounds like they're having SSRI activating mania.

• 21:34Speaker 01

  Making things even trickier is that it appears a lot of people will prescribe Zoloft for those struggling with depression. But unipolar depression, so unipolar means someone that does not have an underlying bipolar disorder diagnosis. That means they just have major depression disorder, right? They will react to the Zoloft vastly differently from someone who has an underlying bipolar disorder. But the front-facing symptoms, like the clinical assessment of both those people, they all indicate depression. They look the same. And to make things even more complicated, the postpartum period has the highest risk window for those with bipolar conditions. Many women report having their very first bipolar episode after childbirth.

• 22:19Speaker 01

  And while postpartum psychosis is really, really rare, it's less rare for people with bipolar disorder versus those without. So one statistic says the risk of postpartum psychosis for those with bipolar disorder is no longer like one in two out of a thousand births, but it's closer to seventeen to fifty percent.

• 22:38Speaker 02

  Wow.

• 22:39Speaker 01

  And again, just because someone has postpartum psychosis does not mean that they are a danger to their children or themselves. They definitely probably need medical intervention, but that does not mean that they're going to commit acts of violence. That's not what I'm saying, but they are just higher risk. And now I will say, the people with bipolar disorder one are usually at much higher risk than people with bipolar disorder two. Bipolar disorder one, just to really simplify it, is a more severe version of bipolar disorder two. And just to reiterate, the conversation is that certain SSRIs can accelerate a diagnosis for bipolar disorder. That does not mean it causes it. The person typically has the underlying condition that was never diagnosed before.

• 23:21Speaker 01

  Also, there are a lot of people who have bipolar disorder and do really well on SSRIs. I believe they are not the only medication that they take typically, but they, they do well on SSRIs. And this should go without saying, but just in case, having bipolar disorder does not make one violent or more likely to harm others. Like, most conditions of the mind, I believe, it is the most damaging to the individual with them rather than those around them or society at large, which it is 2026, we get it, but like, just in case, I have to throw that in there. The reason that we're going so in-depth on a potential bipolar disorder two diagnosis for Lindsay is because that's a huge part of the debate, just during trial, during everything. So at first glance, it seems like this case is about postpartum psychosis and that's the only debate, did she have it or not?

• 24:06Speaker 01

  But the underlying debate for that is whether or not she was showing signs of bipolar disorder, whether or not her providers did not pick up on it and did not treat it, which ultimately pushed her into a state of postpartum psychosis. Bipolar disorder does become a very big topic of conversation. And again, just because it is being debated that Lindsay's usage of Zoloft could have activated a manic response does not mean SSRIs have this impact on anyone that's bipolar or not bipolar. And also SSRIs are known to have saved millions of people. So this is not some sort of fear mongering of SSRIs. And just because it's being debated that Lindsay could or could not be bipolar

• 24:49Speaker 01

  does not mean that her being bipolar is what caused the incident, nor does it mean that anyone with bipolar disorder becomes more dangerous to family members or children? Or does it mean that she should be found guilty or not guilty or not guilty by reason of insanity? I'm just giving you a lot of context.

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  In October, October 24th, 2022, to be exact, Lindsay writes in her iPhone notes, affirmations. I am strong, I am brave, I will get through this, I will overcome postpartum anxiety and depression. I'm a great mom, I love my kids, I love my family, I love my life, I am happy, I take care of myself. Then she has a section titled gratitude. My mom for being there for me no matter what and coming to help at the drop of a hat. My husband for picking up the slack when I've been feeling so down. My husband for taking the big kids out to do things when I felt like I can't. The knowledge of how I can turn things around naturally, the space in my house to do this routine.

• 29:01Speaker 01

  So this is around the time that she starts taking the Zoloft.

• 29:06Speaker 02

  Start of mid-October, I see.

• 29:08Speaker 01

  Yeah, so around the time of Zoloft. Dr. Tufts does give her reasoning for why Zoloft, because that's a huge, again, topic of the conversation. And she says, so it's a first-line medication used for treating anxiety disorders. It's also a first-line treatment when women are breastfeeding. It is the safest SSRI for babies. Tufts says that her initial diagnosis of Lindsay is generalized anxiety disorder and it was adjustment disorder with depressed mood. Dr. Tufts prescribes the Zoloft, like I said, first at 25, then ups it to 50. Lindsay posts on a postpartum Facebook page. It's called I Am Not Alone Postpartum Depression Anxiety and Rage Facebook Group.

• 29:50Speaker 01

  And she writes, looking for advice, no medications for PPA/PPD, postpartum anxiety, postpartum depression. I tried Zoloft and after taking it for a week and increasing it to 50mg, I had extreme insomnia and also felt like it was worsening my depression and I had no appetite whatsoever. So I had to stop taking it. Has anyone had a similar experience and found a different medication that worked? Lindsay also reports this to Dr. Tufts that she took the Zoloft, increased her dosage, and she couldn't go to sleep. Tufts testified that Lindsay told her that she felt awful.

• 30:26Speaker 04

  She did have some stomach aches. She had some diarrhea and had a difficult time eating. She also had increased anxiety. She had some more depressed feelings. She had more difficulty sleeping.

• 30:43Speaker 01

  Tufts notes at the time read,

• 30:45Speaker 04

  that she felt awful, she couldn't sleep.

• 30:50Speaker 04

  Had insomnia, which became worse when she increased the dose. She didn't want to eat. She was having diarrhea. Food felt really unappealing. She was more depressed on it. Crying all day yesterday, which is not normal for her. She had some mental fog and was terrified to start something new. Anxiety was really bad even before med. Now, hard to differentiate. Overnight racing thoughts. Paranoid of getting suicidal thoughts. Something bad happening. Doesn't want to be alone.

• 31:33Speaker 01

  Tufts immediately tells her, stop taking the Zoloft. Now, Zoloft and SSRIs are typically a medication that you cannot stop cold turkey. You have to taper down. But Tufts does explain this dosage was relatively low, so there was no need to taper down off of it. And a lot of physicians and a lot of psychiatrists agree online. So, stop the Zoloft. And they meet again through telehealth six days later, October 26th. And at that meeting, Dr. Tufts says Lindsay was feeling back to how she was before the Zoloft, which is not great still, and that she was considering a new medication. Around that time, Lindsay writes in her iPhone notes. I'm sad and depressed because I'm not able to parent my third child like my first.

• 32:16Speaker 01

  I want to treat any one of my babies like my first, but I know that's not a feasible possibility. I'm sad that I stopped breastfeeding. I feel not as connected with Cal now. I think I sort of resent my other children because they prevent me from treating Cal like my first baby. I know that's not fair to them. I know that. I was feeling so depressed last evening when Cora and Dawson came home from school. I know it rubs off on them, so we had a pretty rough evening. I want to feel love and connection with all my kids. I'm also probably having a bit of internal conflict because my whole life I wanted to have a lot of kids. I still don't want Cal to be our last, but I have a lot of figuring out what to do before I have another. I'm on the fence about starting a new medication for anxiety and depression. I just want to feel happy. I just want to be able to relax and take care of my kids.

• 32:58Speaker 01

  And when they go to bed at night, I want to deeply relax and hang out with Pat and then fall asleep into a deep sleep for eight hours, get up and pour hard into myself for an hour and a half. Callan was so very planned and desired. I want to be able to give him all the love he deserves. I guess that's what it's like to be the third child, though. He's not the first third child to exist. I think I know he'll be okay, but it's really hard for me. I hate that he has to put himself to sleep. I'm sad I'm not breastfeeding anymore, but I think deep down, these are the right choices. She writes that she simply does not have the opportunity to catch up on sleep. She doesn't even have the chance to take a nap during the day. She says, when Cal naps, I have to take care of Cora and Dawson. That's just how it goes. I guess I also feel slightly traumatized by the sleep training,

• 33:42Speaker 01

  but that feeling was only really present when I was severely sleep deprived and paranoid. I know what we did was the right thing and okay. She writes, I still really want a fourth child, but I need a really good therapist before then. I'm on the fence about starting a new med or not. I want to feel happy, but it would be nice to feel authentically happy and not fake. But I need to feel happier than I did last evening because then I was pretty depressed and not enjoying any of my children. It was really sad. I'm struggling so hard because I wanted to parent each of my children like my first. And since I can't, that's depressing to me. And this is definitely the root cause of all our problems. Now I feel like I'm not parenting any of my kids the way I want to, and that makes me sad. But I'm going to try my best today. I've just fallen out of the habit of doing anything for fun, anything for myself, anything for Patrick, and I need to work on that.

• 34:26Speaker 01

  On a positive note, I had a great, deep night of sleep. I'm terrified of something happening to my kids or doing something wrong to mess up their development. Our generation is inundated with information about every aspect of parenting and everything that can go wrong if you just don't get it right. And all the scary things happening in the world, it's insane. For the past five years, I've just filled my mind with all these parenting and it's just unhealthy. This note has been interpreted all sorts of ways online. Some say this note is proof that she knew exactly what she was doing. They think that her journals and her future entries included, which we will cover, show that Lindsay was not hearing any voices, otherwise her writing would have been a little bit more disorganized. There would have been some hint at a voice.

• 35:09Speaker 01

  There would have been more paranoia seeping through these notes. These sound like an exhausted mom who has no way out. Others argue that it shows that she's clearly struggling and trying to get better, that she's screaming for help. She's not getting much help. And a lot of others say this actually could indicate mania.

• 35:31Speaker 02

  Interesting.

• 35:31Speaker 01

  So, there are a lot of people who have come forward and said that when they were in manic episodes, they write like crazy. They talk and they write extensively and, you know, there's a lot of debate online of people. I think the only way really that anyone would be able to know is if Lindsay was some sort of avid journaler prior to all of this. That would maybe clear the air a little bit. Other than that, we're just speculating at this point. But a lot of people have come forward to say, at this point in time, Lindsay is not seeing a therapist. She's seeing a psychiatrist and nowhere in Dr. Tufts' testimony did she say, hey, I told Lindsay to write down her thoughts when she has thoughts. And a lot of people say that it is not a natural thing

• 36:15Speaker 01

  for many people suffering from depression to take a lot of notes unless instructed by a provider. Because the act of taking notes, I mean, with people struggling from major depression, typically they can't even get out of bed. Even basic hygiene is difficult. And so to formulate these longer thoughts and write it all down, it does not seem like it's depression and could maybe be more so mania. And then also, other people are indicating this feels like when people are in states of mania, there's something called pressured speech and we're going to get into it. But it's when someone has so many thoughts and they want to detail all of their rapidly racing thoughts that they just keep talking and then you can't interrupt them. This feels like pressured writing, basically.

• 37:00Speaker 01

  But again, that is just speculative. We don't know.

• 37:03Speaker 02

  So, there weren't a bunch of notes from her app, Notes app? Like messages she written? There's not like a ton of them?

• 37:11Speaker 01

  Well, there were, but in all in this period. So, I don't know if, like, when Lindsay was pregnant with Callan or before, did she?

• 37:21Speaker 02

  Yeah, we don't have that information from the police.

• 37:23Speaker 01

  We don't know if she's just someone who journals like this on a weekly basis. Because that could change things. Now, if she's someone that has never journaled in her life and suddenly she's like writing long monologues in a state where people are saying, you look depressed, or, you know, she's giving off symptoms of major depression. It just, a lot of people think it's kind of strange.

• 37:42Speaker 02

  I see.

• 37:43Speaker 01

  And another thing to note is, some people say that there is this confusion with being in a manic state and it being associated with being euphoric or someone being overly energized and hyper and just talkative and non-stop go-go-go. But there are states called mixed mania where you rapidly cycle through periods of energy and irritability. And then it swings really quickly to depression and it just swings back and forth so rapidly. It is actually considered one of the most dangerous kinds of mania because of the elevated risk of self-exit. Nevertheless, Dr. Tufts then prescribes Lindsay 0.5 milligrams of Ativan, which is basically lorazepam.

• 38:23Speaker 01

  And she prescribes a PRN, which means take as needed, so not a daily medication. Ativan is a benzodiazepine, which means it's going to instantly help with anxiety, but it doesn't do anything to fix the underlying issue of anxiety. Plus, it's highly addictive, so it's not for long-term use. Another example of a very common benzodiazepine that I think more people would be familiar with just due to culture of movies and TV shows, Xanax. Right? It's a controlled substance. And by October 26th, Lindsay tries the Ativan and reports that it did help with the anxiety, but it still didn't help her go to sleep. She tells Tufts that she tried taking over-the-counter Benadryl to help with the sleep since the Ativan only helped with the anxiety and not the sleep.

• 39:07Speaker 01

  So, that is when Tufts prescribes hydroxazine at 25 milligrams. Hydroxazine is an antihistamine prescription and it's offered as an alternative anxiety option. So, this is another PRN prescription, so take as needed. So, instead of taking the Benadryl, take the hydroxazine. That's the idea here. And then take the Ativan when the anxiety is unsurmountable, like when you really need to take the Ativan. But do not take the hydroxazine and the Benadryl together. Then Tufts decides that she's going to prescribe Boost Bar at five milligrams twice daily. So Boost Bar is an anti-anxiety medication that you do have to take every day. And typically, you feel the therapeutic effects within like a week or two. So we've

• 39:49Speaker 01

  dropped the Zoloft, we've added in Boost Bar, which is the daily anti-anxiety medication. Then you have the antihistamine, basically the prescription Benadryl, take as needed. And then you have the benzodiazepine, take as needed for severe anxiety. Lindsay is very hesitant to start the Boost Bar. According to Dr. Tufts, she's just overall very hesitant to start new medication. So while she has the Boost Bar prescription, it's unclear if she started taking it at this point. And Lindsay starts talking to Dr. Tufts about perhaps tapering down from the Ativan. This is November of 2022. So we're like two months in, right? Ativan is a very short-term prescription. There is a huge dependence risk there. So they decide to start a slow taper because you can't even

• 40:34Speaker 01

  just cut benzodiazepines because benzodiazepine withdrawal can be very, very serious. Some have described it as being plunged into the depths of literal hell. You can actually die from the withdrawal. And that's not like a figurative, like, oh, my gosh. You could actually die from the withdrawal. I don't think that would be the case for Lindsay in this particular dosage at this length. It goes to say it's very dangerous. And around this time, on a postpartum forum, November 8, 2022, Lindsay writes in part about Zoloft and Ativan. She writes, "Also, right now, I feel the only medication that works for me is Ativan. It has the perfect effect of decreasing my anxiety and making me feel

• 41:16Speaker 01

  happy. It makes me feel like myself again. But I know that it's not a long-term solution as it is addictive. Any advice on any alternative that has a similar effect?" Which, there's not really many. There's a reason benzodiazepines are controlled substances and are for short-term use. I actually knew someone who was heavily dependent on benzodiazepines. And like, I don't know if there really is anything other than benzodiazepines that could be a replacement. It's kind of considered unmatched for immediate anxiety relief, and that is why it is quite dangerous. And you do get physically addicted to it rather quickly. Then, just for the sake of following the timeline, we also get another Boost Bar prescription

• 41:58Speaker 01

  in November, but Lindsay tells Dr. Tufts that she never started it because she was afraid of, you know, starting new medications. But that, that second Boost Bar prescription does show up. And this is where there is a lot of conversation, and it's going to feel very tricky to follow and just confusing. But there were 13 different medications that were prescribed to Lindsay from September 22 to January 2023. However, some of these prescriptions are replacements to other medications. And just because Lindsay was prescribed it does not mean that she took it, and it does not mean that she was taking all 13 at the same time. It's just very confusing. I will say, even for Boost Bar, just like

• 42:40Speaker 01

  to give you an example, she has two bottles of Boost Bar, two Boost Bar prescriptions, right? For one of them, out of 30 pills, all 30 pills are in there. But another one out of 30 pills, there's only 28 pills. So that means there's two Boost Bar pills unaccounted for. Did she take the two and then decided that she didn't want to take it anymore? If that's the case, it doesn't seem like she reported that to Dr. Tufts, or Dr. Tufts never testified it or had it in her notes. So we don't know. Also, Boost Bar was not found in Lindsay's system on January 24 during the toxicology reports. I will say that Boost Bar's half-life is around two to three hours, and then usually within like, a day, the Boost Bar would be out of the system. But did she take the two Boost Bar pills that are missing? When did she take them? Why did she stop? Why

• 43:24Speaker 01

  did Dr. Tufts not know that she had maybe possibly taken the two Boost Bar pills? So all of this is just, just because she's prescribed something doesn't mean that she took it. It's just confusing. Now, it's not the most pertinent question in this case, but it just goes to show, there's a lot of mental work that we have to make work of, of what she's prescribed, what she ultimately takes, what actually impacts her, what she's prescribed but doesn't take, what she tells the prescribers, and then ultimately what's found in her system, January 24. It's confusing. Dr. Tufts' testimony has sparked a lot of conversation online with people either hating her or thinking Reddington was trying to make her a scapegoat. She is also named as a defendant in two civil suits, one by Lindsay

• 44:07Speaker 01

  Clancy for personal injury and basically malpractice, and a wrongful death civil suit brought on by Patrick Clancy. So they are separately suing a lot of the providers.

• 44:18Speaker 02

  Oh.

• 44:19Speaker 01

  Yeah. And people have a lot of opinions about Patrick Clancy also suing the providers. So there's a lot of, there's a lot of mixed feelings. Some people think that Patrick shouldn't be suing. Some people think that Lindsay shouldn't be suing. And it's just, that is another fight in itself. For Lindsay's civil suit, it states that essentially after prescribing Zoloft, and after hearing Lindsay's reaction to said Zoloft, Dr. Tufts did not recognize the significant role of the reaction. They're saying like, any good provider would realize, like, this is not normal. This is a clear indication that she is, probably has bipolar diagnosis that's underlying, and this activated some sort of manic response.

• 44:58Speaker 02

  Is this being discussed in, in the courtroom?

• 45:01Speaker 01

  Yeah.

• 45:02Speaker 02

  About the bipolar?

• 45:03Speaker 01

  Yeah. I would say that it's not a big part of, obviously, the Commonwealth's case in chief, but the defense brings in a lot of experts, and there is a lot of heavy discussion on bipolar disorder. And then the prosecutors bring in rebuttal experts. It's a whole back and forth. It's not even just a debate of, did she have postpartum psychosis? It's also a debate of, does she have bipolar disorder too?

• 45:25Speaker 02

  Hmm, I see.

• 45:26Speaker 01

  And should these providers have known it? But the civil suit says that Lindsay had such a strong adverse response to a relatively low dose of Zoloft, they should have known. For Patrick's lawsuit, it reads in part, "Dr. Tufts prescribed Lindsay a variety of different medications, but failed to monitor her reactions to these medications or attend to her worsening psychiatric condition." I will say, Lindsay's time as a patient with Dr. Tufts does not end with the new Boost Bar prescription, but there are other providers that get involved later. So just to keep it on Tufts right now, during her direct testimony, Tufts states that she's been a psychiatrist for close to four years now. Lindsay comes

• 46:07Speaker 01

  in to see her, and she indicates in her intake form that she feels decreased appetite, depressed mood, anxiety attacks, easily distracted, excessive worry, guilt, unable to feel pressure, unable to fall asleep, racing thoughts. She reports that she feels down, depressed, and hopeless more than half the days. And Dr. Tufts says, "It is part of her job to look for signs of psychosis in patients." So when she's asked about those signs, she says, "It might be that they appear disheveled. I assess what their attitude is. If they might be agitated or very uncooperative, that's a red flag. I will assess what their speech is like. Is it very loud? Is it very fast? Or sometimes it could be the opposite, where they're not really even speaking at all. I assess what their mood is like, what

• 46:52Speaker 01

  they're saying that they're feeling, and how they appear visually." She says that she looks for disorganized thoughts. And that's typically through like the content of the conversation. If anything sounds very bizarre or very paranoid, that would potentially be indicative of psychosis. And she says she does that by asking questions like, quote, "Have you ever heard voices? Have you ever seen something that other people didn't see?" Which, some people are like, these are pretty bad questions, but, I mean, I think it's probably protocol, right? Tufts believes that she asked Lindsay, and Lindsay's response was no. During the cross-examination, defense attorney Reddington first questions Tufts' experience as a psychiatrist. Because when she sees Lindsay, Dr. Tufts had completed

• 47:36Speaker 01

  her residency and had been practicing as a psychiatrist for a little more than a month. I do see a lot of people harping on this issue. I have been down lots of forums of people that are in healthcare. That's the whole point of residency, is you get the experience through residency. So a lot of people think that this is incredibly unfair for this to be the focal point. However, there are other things to take issue with. This just might not be one of them. But people have taken issue with it. Reddington asks Dr. Tufts, "I'm asking you, when you started working in August of 2022, how many patients had you treated before you saw Lindsay Clancy for postpartum psychosis?" So he's saying like, how many other? And she says, "Well, in the span of one month, I would say none

• 48:18Speaker 01

  because it's a very rare disorder." How about postpartum depression? How many people in that month or so before you met Lindsay did you treat for postpartum depression? In the span of one month, it's really hard to pinpoint that. Maybe a couple? The clinic that Dr. Tufts is working for had her on the website as, okay, well, this is what Reddington says, "Well, one of the things you did is that you said that you were basically a specialist in the postpartum. You indicated that on the website, didn't you?" Tufts says, "It's listed as one of her interests." Lots of you have problems with this. Okay, netizens are like, "Yeah, okay, next time, I'm just gonna list shit on my resume and say it's an interest of mine." Reddington says, "And again, forgive me, how many women did you treat for postpartum depression

• 49:03Speaker 01

  in that month and a half before you met Lindsay?" "I don't know, maybe a couple, but I've treated many of them in residency, which was just immediately before." Some believe that Reddington is too antagonistic, asking about Tufts' residency. And I think a lot of people can agree that maybe the clinic that she was working for probably should not have listed her for something that is as complicated, even if it says the word "interest" on there, like, "An interest of Dr. Tufts is women's healthcare and postpartum." People think that it's incredibly reckless for the clinic to list her, who has just been working independently as an attending for like, a month and a half, when this is such a sensitive, even for people with years and decades of experience, very difficult

• 49:48Speaker 01

  to identify. They think that was reckless. However, they think that Reddington, on that same note, is also reckless in his line of questioning. But you do have to remember, the jurors are probably not healthcare professionals. I mean, there was a nurse on the jury, but you're talking about a lot of people who are not healthcare professionals. So while this cross-examination, when I was on healthcare forums, they were saying it was the worst thing that they've ever heard in their lives, and they were getting pissed off at Reddington. But a lot of people are reminding them, "Reddington is not doing this for you, or for healthcare. Reddington is doing it for the jurors."

• 50:23Speaker 02

  He's picking whatever angle is going to work on a normal person, yeah.

• 50:27Speaker 01

  And this is the angle, where he's asking about her doing residency during the pandemic. Did you touch people, shake their hand, give them a hug or anything like that while you were working in your residency during the pandemic? Sometimes, I think everybody had to keep their distance at certain times. I began my program before the pandemic, so of course, there was a lot more handshaking and things like that then. Reddington asks Tufts, "You're defendant in a very large lawsuit, are you not? Objection? Overruled."

• 50:56Speaker 01

  Yes, and you know that the outcome of this case is very major to the outcome of your lawsuit. Objection, overruled. I don't actually know that. So you understand that if in fact it's determined that you advertised as an expert in postpartum and in postpartum psychiatry and you've had a month experience plus a residency, would you consider that to be negligent or misrepresentation? I do not believe that I have been negligent. With a month under your belt plus your residency, do you really want this jury to believe that you were an expert? I don't think that's exactly the wording that I used. I think I said it was an interest of mine. Are you an expert in postpartum? I may be, I don't know.

• 51:39Speaker 01

  I think it depends on what you define an expert as. Tell me what brought Lindsay Clancy to your office? Postpartum anxiety. Reddington points out that Dr. Tufts does not administer the Edinburg test for Lindsay, which Tufts says she did do a different test, the PHQ9, which is kind of like an overall depression screening form. But Reddington argues that's like generalized anxiety disorder, generalized depression. It's got nothing to do with a woman suffering from postpartum depression, does it? I disagree. Well, do you agree that people perhaps that may know a little more than you determined that the Edinburg scale is the appropriate scale to administer to a pregnant or postpartum woman?

• 52:22Speaker 01

  Objection, sustained as to form. The form of the question is not okay. You're familiar with the Edinburg scale, right? I've heard of it. And can you explain to me how it's graded? No, I cannot. There are thirty questions in it, are there not? I don't use the scale, so I don't know how many questions there are. This is not Dr. Tufts' problem if her clinic does not use the Edinburg scale. However, I think the point that Reddington is trying to make is even if you list postpartum as an interest, but you don't even know the Edinburg scale, which is one of the bigger, bigger well-known screening tests for postpartum anxiety and depression. Is it really an interest of yours?

• 53:07Speaker 01

  Even if that's not the screening tool that you use at the clinic, should you not at least know it? Because what if a patient comes in and is like, hey, yeah, I took the Edinburg scale with my last provider and I was like this? Should you not have a good idea of it? And it's not an overly complicated scale either. It's not like some crazy terminology and then you gotta draw blood. It's just like a screening tool, like the GAD7.

• 53:30Speaker 01

  Tufts pushes back later, saying that it's not really her choice whether or not she gets to use the Edinburg scale or the PHQ9 scale. That's the practor, aster, the clinic. That's what they use and that's what she uses because she works for them. Reddington also makes it a point to show the jurors that they had fourteen appointments from September to January. Fourteen appointments between Dr. Tufts and Lindsay and every single one of them was telehealth. Yes.

• 53:57Speaker 05

  Every single one of them were by telemedicine, weren't they?

• 54:01Speaker 01

  Yes.

• 54:02Speaker 05

  Until you came in this courtroom Friday, you never saw this woman in person, did you?

• 54:07Speaker 01

  Correct.

• 54:08Speaker 05

  She was crying? She told you symptoms that she couldn't get out of bed. Isn't that right?

• 54:16Speaker 01

  At one time, she said it was, it was difficult to get out of bed.

• 54:19Speaker 05

  Oh, difficult to get out. Why was it difficult for Lindsay Clancy to get out of bed?

• 54:23Speaker 01

  Because she was very depressed.

• 54:24Speaker 05

  And, and did you give her a hug? Oh, no, you're on telemedicine, so you couldn't give her a hug, could you?

• 54:29Speaker 01

  Okay, this is where I did think it went a little skewed. I do think like based off of the interviews that we've seen of the jurors so far, I think I can understand the ploy that Reddington is trying to make for the jurors that are in front of him. There's so many times he doesn't call it Zoom, he doesn't call it computer. He says you saw her through the television. And he himself being an older man, it does seem very old school, but there might be many members of the jury that resonate with that. However, a lot of younger people online are like, I only do telehealth, so I don't know what he's talking about. So there is a generational gap here of, but I can see why he's doing it.

• 55:11Speaker 02

  He's critiquing the tele.

• 55:13Speaker 01

  Yeah. Now, is that the morally correct thing to do? That's up for debate. Is that the smartest thing for a defense attorney to do? Probably. So that's probably why he's doing it.

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• 59:53Speaker 01

  Dr. Tufts argues, I mean, she doesn't argue, but she responds. I could look at her, but it was always a video appointment. I couldn't give her a hug, but that's not actually something that psychiatrists typically do with patients. Reddington points out that the angle of the camera and the teledoc appointments, you can't see certain manifestations that patients may have, and that would point to them being stressed or emotionally disturbed, he says, like hand wringing.

• 1:00:19Speaker 01

  She's like, yeah, were you able to see the hand wringing when you were on telemedicine? I don't recall seeing her hands. You recall how people sit there and they, they do this with their leg and their leg bounces because they're going through some type of emotional stress. You couldn't even see her legs, could you?

• 1:00:36Speaker 01

  I couldn't see her legs, but I knew that she was under stress. I think that, um, I think Reddington is setting the scene. He's setting the scene because later on, a different provider comes on and she states that ultimately she felt Lindsay's condition. She wanted to see Lindsay in person. And I think he knows that's coming, and I think he's making an extra emphasis on Tufts' testimony at this point. To really hammer in throughout the times that you've seen her, you never once even considered telling her to come into the office. So this is again, he's trying to pinpoint, no one was giving Lindsay the help that she needed. Dr. Tufts says whether an appointment is in person or through telehealth,

• 1:01:19Speaker 01

  that's really up to not just Dr. Tufts, but also the patient. She says if a patient ever wants to do it in person, not through telehealth, that is an option. Some parts of the cross-examination that people are on the fence about, I will say, is Reddington asked Tufts about whether or not Tufts told Lindsay that self-exit thoughts and actions are side effects of Zoloft. Tufts argues that that is mainly for children, but Reddington says there's a black box warning on Zoloft and other SSRIs, is there not? Tufts argues, yes, but it's mainly for children and adults that are younger than Lindsay. So the FDA determined that there is a self-exit risk for children and anyone under the age of 24 years old.

• 1:02:00Speaker 01

  So Reddington is arguing, well, Lindsay was 32, which is just like a few years older than 24, he says. He never even mentioned she's 32, he just keeps saying like a few years. So does that suddenly mean that she's no longer at risk taking Zoloft of having thoughts of self-exit? Tufts argues back, there's a lot of development that happens in the brain between ages of 24 and closer to 30. The brain is fully matured at past age of 24, so it's less vulnerable than in a younger individual. So with 24, you're suggesting there's a cutoff. Are you suggesting to the jury that a drug that increases the risk of self-exit in a 24-year-old patient cannot increase the risk of self-exit in a 29 or a 30-year-old patient just a little bit? I don't believe there's evidence that it causes that at all in individuals over 24.

• 1:02:46Speaker 01

  Now, I can see why people don't love this argument. There is a lot of demonization and fear mongering of SSRIs that is coming out of this case. And SSRIs have been life-saving, incredibly helpful for millions of people everywhere. Like on a global scale, SSRIs have, there are horror stories, of course, like with any medication. But there are people who would not be here without SSRIs. So they think that this type of language and that Reddington is using is only going to scare people from starting an SSRI when it's probably the best line of treatment for them. I guess maybe a more valid argument could be Reddington argues that another side effect of Zoloft could be, quote, severe trouble sleeping, insomnia. Did you tell her that?

• 1:03:31Speaker 01

  Well, insomnia is listed as a side effect. No, no, no, no, no. Did you tell her that Zoloft has a side effect of giving the patient severe trouble sleeping? That's all. So I didn't use the word severe because it typically doesn't cause severe trouble sleeping, but I thought that you were referring to when she told me that she had severe trouble sleeping. But she's basically saying like, she didn't think that Zoloft and the problem of not falling asleep was a big problem for Lindsay. But Reddington is arguing, why would you prescribe Zoloft to a young woman who's postpartum, who's coming to you with anxiety? This is his direct quote, who's telling you she can't sleep. She's got all these symptoms and then you prescribe a medication that would have had a side effect of trouble sleeping. So individuals have very varied responses to medications.

• 1:04:16Speaker 01

  Some have no side effects, some have one or two. It's impossible to predict that. Zoloft is a top choice, a first-line medication for her. Says who? The general consensus among psychiatrists. There's extensive research supporting the use of cetrulene in this instance, and the general consensus among psychiatrists that it's a first-line safe medication for individuals, including postpartum women. How about the kids that shoot other kids in high school and the lawsuits that come out against Zoloft? Okay, so again, this is the part where I do think that Reddington is demonizing Zoloft for...

• 1:04:49Speaker 02

  Really interesting, he's going after

• 1:04:51Speaker 01

  Yeah.

• 1:04:52Speaker 02

  A specific medication.

• 1:04:54Speaker 01

  Just for the defense of his client. I think there's a lot of other ways to defend his client. I think, again, we're just heading into weird territory here with the SSRIs. That gets objected, overruled, um, but he continues to ask. So you didn't really talk to her about increased risk of self-exit with 24-year-olds? Because she's what, four or five years older than that? You didn't talk to her about the trouble sleeping, which could be a side effect? He asks her if there couldn't be any other drugs that she could have prescribed that would have been perfectly safe and common and allows someone with no psychiatric history to sleep better? And she responds, not necessarily. Reddington starts asking about Lindsay's reaction to Zoloft.

• 1:05:33Speaker 01

  And again, one of the things that Lindsay tells Tufts is the mental fog, racing thoughts, doesn't want to be alone. Doesn't want to be alone, what does she mean by that? Well, those were a lot of her words. Right, isn't that a concern? If your patient is telling you she doesn't want to be alone, why didn't she want to be alone? So he's trying to hint at, like, usually people say that, but as a mental health professional, that typically means they might be scared of something or paranoid. You can't just take it as, I don't want to be alone. And she says, and I think, you know, there is a debate. A lot of medicines also say, you know, when you are dealing with someone with pretty severe depression, they want to be alone. But she's saying she doesn't want to be alone after taking the Zoloft and she's having these racing thoughts.

• 1:06:17Speaker 01

  A lot of people think it's pointing towards mania and paranoia. So it's just like, she should be able to pick up on that, is what people are saying. But Tufts says, because she was very anxious and had the feeling like something bad might happen.

• 1:06:31Speaker 01

  But we never get a clear idea of like what that something bad is. And later Tufts says, it's very different. There are fear of thoughts of self-exit versus actual thoughts of self-exit. She said, say a patient might say they're having self-exit thoughts, but when they describe them, they're not actual self-exit thoughts. There are fears of self-exit, so that's the difference. And, I'm sorry, I think I forgot exactly what your question was. Reddington points out more notes from Tufts near December, where Lindsay denies to Tufts that she feels like she wants to self-exit, but she feels close to feeling suicidal. Reddington asks, so she was dwelling on it or thinking about it, right? Is that fair? She was fearful of eventually having those kinds of thoughts to self-exit.

• 1:07:16Speaker 01

  Yes. And how frequently were those thoughts? I'm not sure exactly how frequent they were. Did you ask her? It's very likely that I did ask her frequency, but they're not in the notes. Would that be in your medical records? When you see some patients, you have some patients other than Lindsay Clancy at that point, right? Yes. And you document when a patient, my God, when a patient comes in and tells you that she's postpartum distressed and she's close to having self-exit thoughts, to self-exit, that's important, isn't it? It's important that I'm aware that she's having these thoughts. What thoughts? That she is fearful to become suicidal. And she told you, I imagine, or you asked how frequently these thoughts were. I don't have that documented, how frequently they were,

• 1:08:01Speaker 01

  but it is a question that I usually ask when we're talking about self-exit thoughts. When we're usually testifying in a murder case, we usually have facts that we can tell the jury, not speculation. Objection sustained. Would you agree with me that many times, patients, especially psychiatric patients, may minimize their symptomology? Patients sometimes do. And sometimes when a woman that has just had a child and other little kids at home, you feel worried about the government taking the kids away from them because you're a mandated reporter, aren't you? Objection overruled. You're a mandated reporter, aren't you? I am. She says, having self-exit thoughts alone is not a reportable condition.

• 1:08:42Speaker 02

  Doctor said that.

• 1:08:43Speaker 01

  Yeah.

• 1:08:45Speaker 01

  We don't know how frequently she was having them, yeah? Today, I don't know how frequently, but at that point, I believe I did know how frequently. Tufts didn't know that Lindsay called the self-exit hotline twice during this timeframe, nor did she ever ask about it. Reddington asks, is it a surprise to know that she called the hotline in that timeframe, not once, but twice and was turned away? You guys were on the front line of this, weren't you? It does surprise me, yes.

• 1:09:10Speaker 02

  What do you mean turned away?

• 1:09:12Speaker 01

  Um, this is where a lot of people are upset with the system, but even that is a larger conversation, right? You can have thoughts of self-exit, but typically you are not taken in on a psychiatric hold unless you have a plan.

• 1:09:28Speaker 02

  Okay, so she called and they just?

• 1:09:31Speaker 01

  I guess they tried to talk her through it, right?

• 1:09:35Speaker 02

  Ah, I see, I see. That's what he meant by turned away.

• 1:09:37Speaker 01

  Yeah.

• 1:09:37Speaker 02

  That she wasn't taken in and I see.

• 1:09:40Speaker 01

  And you never asked if she ever called a hotline, did you? I don't think that I did. Now, there is debate online of whether this is more of a problem with the field of how psychiatry is practiced, or if it's a Dr. Tufts problem. But Reddington is asking Dr. Tufts about how Lindsay told Tufts that she's feeling like self-exiting and Tufts says, I asked her, so what do you mean when you say I'm feeling self-exit, like suicidal? And that's when she said, it means I'm feeling hopeless. And then I asked, do you have intention of harming yourself? Do you have a plan of hurting yourself? And she denied those. Which Reddington later asked, what's the difference? And Tufts says, a plan means that they know exactly what they're going to do to do the plan.

• 1:10:22Speaker 01

  You know, what they're going to use, maybe when they've researched it and that presents an immediate threat and that is something that would require hospitalization. Which now, a lot of people argue is just semantics and of course, no one is going to risk being sectioned by saying, yes, I have exact plans. And also, a lot of self-exits are not meticulously planned either. In fact, I think statistics show that most of the time that they are not planned. But again, does that fall on Tufts or does that fall on the guidelines that are put in place? But what would be the better alternative? Because I don't think that we should also just leave it fully up to the provider's full discretion, whether or not a patient is sectioned. Because for their own malpractice, they would just start sectioning fucking everybody. And that would also be very dangerous and could result in worse outcomes.

• 1:11:05Speaker 01

  So we could go in circles in point shoes, but I just don't know if we would end up in the same spot. And I don't think that I'm equipped because I have no experience in healthcare to even really understand the full scope. But that is a full conversation that's happening online. Reddington asks Tufts, now you'd agree with me at this point, prior to the next appointment, which was November 2nd, that it had gotten significantly worse, even after all this medication that you've been prescribing, right? Did you make a note that she was telling you that she had depression and that she was crying, had more anxiety, insomnia, had increased brain fog and worrying about self-exit? In the couple of weeks after starting those medicines, I don't recall that the symptoms were significantly exacerbated. Okay, and did she tell you about intrusive thoughts that she was having? And what were those intrusive thoughts?

• 1:11:50Speaker 01

  It was the feeling like I'm going to die. And this is where I guess people have some, this is also another nuanced debate. Some people think that Tufts comes off really cold. Okay, this is aside from the medications, right? Some people think that Tufts comes off really cold and does not do enough to help Lindsay. Other people argue that Tufts is a psychiatrist, so she really is a prescriber of medication. She's less of a talk therapy. Tufts does recommend Lindsay to a few therapists that she could talk to. So there is like this back and forth of people of, was it really her job? So for, and this is the line of questioning that kind of sparks that debate.

• 1:12:34Speaker 01

  Reddington asks, you indicated that she can't sleep, she's panicking, she had worse depression, intrusive thoughts, she was numb, nothing mattered. Quote, I feel like I'm gonna die, denies SI, but SI is um, suicide ideation. Denies SI, but quote, yesterday, close to it, feeling hopeless. Did you give her therapy and validations after she told you that? I believe I did. What did you do? You've got a woman that's telling you that she's hopeless, she doesn't care if she dies, can't sleep. What did you do to validate her on your therapy? I told her that this is something that we could address, that there was hope, that there were treatments. There were different types of treatment programs that are more supportive, like partial hospitalization programs.

• 1:13:19Speaker 01

  You agree that she had, in your opinion, a severe mental disturbance at that point that was manifesting itself. She had moderate and moderate heading towards severe. So this is where people are like, okay, well, if you're in a really bad state and someone's telling you, don't give up, there's hope. That would also send you into a spiral, but then others are arguing, yeah, but she is a psychiatrist and like, a lot of people are like, I only see my psychiatrist like once a month and she asked me three questions of like, how are the meds? Great, okay, prescribing another one, sounds good, bye. So people are saying like, are we looking for the wrong things with the wrong providers? There's a lot of debate to be had. Other people are saying hindsight is 2020 and she only seems heartless now, but these are how all psychiatrists are. And if you have a problem with that, you probably have a problem with psychiatry, but it's, I don't know.

• 1:14:05Speaker 01

  One interesting aspect, though, I think that does not get talked about enough, is that Lindsay stated to Dr. Tufts that she was having about one to two alcoholic beverages about five times a week. Which is quite a bit considering she does have an Ativan PRN prescription. You cannot mix benzodiazepines with alcohol.

• 1:14:25Speaker 02

  Oh, and she told the doctors that?

• 1:14:27Speaker 01

  But I imagine, it's just like brushed up on, Tufts mentioned that she did not see a problem with that, but I would imagine that Tufts was telling her like, you can't take benzos with alcohol. But I mean, some people think that is a lot of alcoholic beverages. And maybe she was self-medicating through alcohol to stop with the anxiety, no one, but it's just um, it's just not a bigger topic, which is why we don't get much clarity, but it is, it's kind of weird. But people are ultimately divided on how they feel about Dr. Tufts. Her care for Lindsay, her treatment decisions, her testimony, her court demeanor. There are a lot of people who defend Tufts saying, Tufts spent more time with her than lots of doctors who get sued, so.

• 1:15:08Speaker 01

  Another writes, the worst is knowing that all these providers actually legitimately tried to help Lindsay. It's not like an obvious case of medical gaslighting or malpractice. Another person says, Dr. Tufts was not negligent. If you're dealing with a patient who is non-compliant and takes some pills here and there and some pills there, who doesn't give the different prescriptions enough time to become effective, is not forthcoming with everything, that's not the psychiatrist's fault. Other comments that it's weird to defend Tufts, they write, Lindsay exhibited signs of bipolar. So people are saying like, everyone's getting lost in all the testimony, when the one thing that people should be worried about is that after Zoloft, Lindsay was exhibiting signs of bipolar.

• 1:15:48Speaker 01

  But others argue there were no like contemporaneous signs that Lindsay was exhibiting symptoms of mania. It's up for debate, but they write, Lindsay exhibited signs of bipolar and Tufts completely missed it. Not only did she continue feeding her medicine that counteracts with bipolar, but she let the illness go and treat it as well. This is literally the equivalent of not treating cancer because you don't detect it. Her mental illness grew faster and stronger without proper medication and the incorrect meds. It is sickening to hear people say, she did her best. Three babies died and a woman is paralyzed, her best was not even close enough.

• 1:16:24Speaker 01

  Another thing is, a lot of people in healthcare do point out that you have to be extra cautious when someone is postpartum. Because very quick way to activate a manic state is sleep deprivation. And you're gonna have a lot of sleep deprivation when you have a baby.

• 1:16:43Speaker 02

  Yeah, they're all sleep deprived, yeah.

• 1:16:45Speaker 01

  And a lot of times, women or people who give birth and then have bipolar episodes afterwards, they are not what is very obvious signs of bipolar manic episodes, they're usually in a mixed state. So it can easily be confused with postpartum depression. Another person in the residency subreddit points out that while they have sympathy for Tufts, they do think that there's a lot to learn from the way that she takes notes. Her medical notes that were used in court. The fact that Tufts also wrote that Lindsay was quote, close to SI, they think is really bad because either you have SI or you don't, that could be legally used against you. Or if someone is quote, close to SI, that's a very insufficient description, you have to back it up with more notes.

• 1:17:28Speaker 01

  They also state that they understand why the general public who is not in psychiatry is not sympathetic towards Tufts. So while they are sympathetic, they can see easily why the general public is not. They think that she appeared grossly unprepared for cross-examination. An example being, you know, when questioned on why telehealth only and why she has never met Lindsay in real life, Dr. Tufts should have highlighted that it makes psychiatric care more accessible for a busy mom with three children. She did not answer any of those questions well. But another highlighted example is later, Dr. Tufts, she's asked about one of the notes about pressured speech, we're gonna get into it in this episode. But she says to Reddington, I don't care what was written, I know what I meant.

• 1:18:10Speaker 01

  So she has a lot of these moments where her notes are not good enough and she's almost defensive about her own notes. And that could be the stress of the lawsuit and her career at risk, right? Now, I can't tell you the exact data points, obviously, but it appears that a lot of therapists, physicians, psychiatrists, healthcare forums with practicing providers, they either feel like a little too somewhat too fully sympathetic for Dr. Tufts. They don't think that she did everything perfectly, but they can see how it happened. Knowing the healthcare system, knowing how these things work, they don't necessarily think that she should be sued for malpractice. But they think her documentation was horrendous and that people need to learn from that. And her preparation for the cross-examination was also horrendous.

• 1:18:54Speaker 01

  They also critique a lot of the system rather than Tufts herself. Others are more focused just on the system as a whole, saying, this shows what's wrong. Doctors are incentivized to prescribe medication, have quick visits and pass blame to others. What a shame. Others believe that Tufts, whether you like her or not, and whether she did make small mistakes that are not negligence, not enough for a malpractice suit. They think that more of the hate should be on the system rather than the provider itself, is what some people are saying. One person writes, it became very clear to me when watching her testimony that this was not negligence and rather a clinician who was operating within the constraints of the system. Given imperfect information, difficult to detect presentation, treating a patient whose engagement and medication decisions were changing.

• 1:19:41Speaker 01

  However, a lot of people in psychiatry point out, no, there, there's some bad here. So the first being that Lindsay later has a lot of other providers and none of them are talking to each other. I wouldn't say none, but the most important ones are not talking to each other.

• 1:19:57Speaker 02

  How did that happen? Is it just how the system is set up?

• 1:20:00Speaker 01

  Yes. So Lindsay goes and sees another provider who is also prescribing and then Lindsay goes and tells Tufts, "Oh, my other provider just prescribed me this and this and this and like, what do you think?" Right? It would make the most sense for Tufts to then say, "Hey, can you fill this form so I can get the records from that provider? And maybe I can even talk to that provider so that we can be on the same plan for the same treatment plan, right? She never does that. She just takes Lindsay's word for it and the other provider equally does the same thing.

• 1:20:24Speaker 02

  Interesting. Is that like a common practice? Is that?

• 1:20:28Speaker 01

  Um, that's up for debate. So a lot of people on the healthcare forums say this is incredibly common.

• 1:20:34Speaker 02

  Wow.

• 1:20:35Speaker 01

  Other people say it's, some people say it's like hindsight is 2020.

• 1:20:40Speaker 02

  Wait, so they don't share their medical charts, their histories and all of that?

• 1:20:44Speaker 01

  No, unless you're in the same system. So the few people that do communicate with each other, they're in the same healthcare system. So they have the same, like they both work at the same hospital. So they have access to the other provider.

• 1:20:55Speaker 02

  That's so interesting because like even when we take Mango to the vet, they have to get their records, no?

• 1:21:00Speaker 01

  Yeah, yeah, you have to get, but you have to sign the release forms. And I think the point that Reddington is pointing out is that Tufts never even had Lindsay sign their release forms. And then other psychiatrists are saying it's really not the craziest thing. Like it's kind of pretty common to know that SSRIs, that type of response does point towards a mixed bipolar depressive state. However, they also argue the distinction can be really hard when um, everyone responds to medications differently. And maybe she was not showing signs of mania as much. So it's, it's still up in the air, but others are saying, "No, that's a pretty common knowledge. It's like, oh, we should be working, looking out for this."

• 1:21:42Speaker 01

  But others just focus on the fact that, listen, she admittedly did not have specialized training in perinatal mood disorders. It was inappropriate to advertise herself as having some sort of specialty or even interest in it. This alone deserves a lawsuit. Another person writes, "She is aware that her notes are medical records, right? Dr. Tufts continues to see Lindsay throughout September, October, November, December, and ultimately January. Her last appointment with Lindsay is January 23rd, the day before the incident. And one of Tufts' notes will be argued and dissected in court. But first, we have to go through all the other providers that Lindsay had seen in that timeframe.

• 1:22:25Speaker 01

  And that is where I leave you with the first half of this episode. Let me know your thoughts. The second half of this episode will be up for the audio podcast very quickly. And let me know your thoughts. Stay safe and I will see you in the second half.

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