“My Wife Is Not Bipolar” Nurse Testifies & All The Signs of Possible Hypomania Discussed in Court

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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• 1:27Speaker 00

  November 16th, 2022. Lindsay goes to the South Shore Emergency Department. This is the same hospital that she gets sent to January 24th before she's med flighted.

• 1:38Speaker 01

  Okay.

• 1:38Speaker 00

  So November 16th, she goes into the emergency department and she's like, I have severe insomnia. She is prescribed Chasidone at 50mg for sleep. She takes it home. She doesn't stay. She's not like inpatient. She just goes to the emergency room. She gets a prescription and she later reports to Dr. Tufts that she went to the emergency room, got Chasidone, and it had very minimal effects on her. Two days after this emergency room visit, November 18th, she writes in her journal, Tree of Life Journal. It's like I'm so desperate to get a mental break from taking care of everyone that my mind is trying to make something physically wrong with me. My mind never shuts off. It's constantly thinking of the next thing someone needs. I can't shut it off.

• 2:21Speaker 00

  I desperately want to go back to work, but now I don't know how to function and it worries me. Now that we're in the month of November, the medication switching gets really fast. And from there, December does not get any better, at least in my opinion. It would appear that November and December, Lindsay is going through a very active, rapidly changing psychiatric treatment period. So from September 15th, 2022 to January 23rd, there are approximately 35 prescription dosage changes, taper, or treatment plan events that involve 13 core psychiatric medications. So it's like 13 medicine and then they're like, okay, well, let's ramp it up. Let's decrease the dosage. Let's swap. And it's 35 different plans. So you have Zoloft SSRI.

• 3:07Speaker 00

  You have Ativan, which is a benzodiazepine, hydroxazine, which is like a prescription antihistamine to replace the Benadryl, Boost Bar, anxiety medication, Chasidone, an antidepressant, Prozac, a different SSRI, Ambien, a sedative sleep medication, Remarin, an antidepressant, Klonopin, a benzodiazepine, Serquel, antipsychotic, Valium, another benzodiazepine, Lamictal, an anticonvulsant and mood stabilizer, as well as Allevil, which is an antidepressant. We literally have a cocktail of antidepressants, benzodiazepines, sleep medications, antipsychotic mood medication, and a mood stabilizer moving in and out of Lindsay's med regimen.

• 3:49Speaker 00

  Now, I'm not saying they're moving in and out of Lindsay, but it's a constant up and down, increase, decrease with the dosage, and she's clearly not getting better. Thanksgiving 2022, two months before the Clancy children are killed. Lindsay is showing signs of depression. Her husband, Patrick, takes the stand and there's gonna be a lot more on Thanksgiving in the next part, because there's a lot on Thanksgiving. But he's being asked about Thanksgiving. What was Lindsay like?

• 4:15Speaker 02

  She wasn't talking much. She had low energy. She was really depressed. I just remember when she showed up, um, my sister-in-law gave her a big hug.

• 4:25Speaker 03

  And um, she was able to get through dinner, eat dinner with everyone?

• 4:30Speaker 02

  Yeah.

• 4:31Speaker 03

  And when she told you she was suicidal, did you ask her if she had a plan on how to kill herself?

• 4:38Speaker 02

  Yes.

• 4:38Speaker 03

  And what was her response?

• 4:41Speaker 02

  She said no.

• 4:42Speaker 00

  And at some point in time, did she tell you that this was the first time she was having these thoughts? I don't know if she mentioned it was her first time or not. I just remember her saying she had them. Patrick's mom, Sue Clancy, more on her later as well, is also a nurse. She works at South Shore Hospital. So this is again, the same hospital.

• 5:00Speaker 01

  Same one?

• 5:01Speaker 00

  Yeah, she is. So Lindsay is, well, she was a nurse, a labor and delivery nurse at Mass General, but she gets taken to South Shore and Sue Clancy works at South Shore in labor and delivery. And she recommends Lindsay to see a woman named Julie Paul. Julie Paul works at South Shore. She's a psychiatric mental health nurse practitioner who can prescribe. She is board certified and this alone.

• 5:25Speaker 01

  Wait, hold on. This is so crazy.

• 5:26Speaker 00

  Yeah.

• 5:27Speaker 01

  Patrick's mom is a delivery nurse?

• 5:30Speaker 00

  Labor and delivery nurse. And his new wife is also, she is in the.

• 5:33Speaker 01

  Oh my god.

• 5:34Speaker 00

  She's in REI. So there's just like a lot of.

• 5:37Speaker 01

  Whoa.

• 5:38Speaker 00

  Yeah.

• 5:39Speaker 01

  She must knows, you know, like this is kind of her life, dealing with women that's.

• 5:44Speaker 00

  Wow. Dealing with people who get.

• 5:45Speaker 01

  Yes. Yeah, yeah, yeah. Wow.

• 5:48Speaker 00

  So she recommends her to see Julie Paul and she is a board certified nurse practitioner. This has spawned a new debate. Like I'm telling you, every single fucking thing that we talk about is a freaking debate online and it's, it's just so heated. There's now a whole debate on nurse practitioners. Should they be allowed to prescribe?

• 6:10Speaker 01

  Okay.

• 6:11Speaker 00

  And like, there's a whole.

• 6:13Speaker 01

  Okay, what happened?

• 6:15Speaker 00

  Just because nurse practitioners have, I would say probably less academic training for prescribing in the field that they are prescribing.

• 6:25Speaker 01

  What's her, Julie?

• 6:26Speaker 00

  Julie Paul is a nurse practitioner.

• 6:27Speaker 01

  And she prescribed something?

• 6:29Speaker 00

  Yes, but more so later, there's another nurse practitioner that enters the conversation. And so now there's a whole debate on Reddit forums of, you know, MDs, doctors saying like, we should never let nurse practitioners fucking prescribe shit. And then nurse practitioners be like, yeah, well, we should. And then there's, who cares more about the patient? And that itself is a huge beast of a conversation that, again, I'm not in healthcare. I've never worked a day in healthcare in my life, so I really have no say, but you know, but I'm just saying it's out there. That conversation is out there. So she's like, maybe you should see Julie Paul. Julie Paul is the director of the Perinatal Behavioral Health Program at South Shore, which specializes in pregnancy and postpartum. Now Julie Paul is, well, she was, and this is a misconception out there.

• 7:14Speaker 00

  She was one of the few providers not being named in the lawsuit by Lindsay or Patrick, but I believe she is now listed as a defendant in one of the civil suits. So there was a lot of, I think, praise for Julie Paul during her testimony, knowing that she was not being sued by either of the Clancys. But um, I don't know. There's just, yeah, it's like a moving mess, right? Julie Paul reaches out to Lindsay after Sue Clancy refers her. But I, I would say that Julie Paul is one of the more liked healthcare professionals. November 2022, Julie Paul starts asking, calls Lindsay, asks about Callan's birth and Julie testifies.

• 7:58Speaker 00

  She said that she did really well for the first 12 weeks. She was excited, really happy. And then Patrick went back to work and she said she started to struggle with some anxiety. Lindsay expresses to Julie that she was concerned about Ativan and Benadryl. Julie says she'd been taking it for two weeks and it was working really well, the Ativan, the benzo, but she was getting concerned about dependence, so she self-weaned herself off of that. She reports to Julie feeling overwhelmed now, having three children, but she experienced this to some extent with her second pregnancy with Dawson. And Nurse Julie wants to put Lindsay on Prozac, which is an SSRI. Because Lindsay had told her that way back in nursing school, she had actually taken

• 8:40Speaker 00

  Prozac before and she didn't really have any crazy symptoms or side effects from Prozac other than sexual side effects, but you know, that's not the biggest problem right now, right? So she's like, instead of just trying other SSRIs, let's try Prozac. Like this is a known medication to you rather than taking shots in the dark. This is a good start. Now Prozac is again, another SSRI that we are prescribing to someone who may have an underlying bipolar disorder that is not counteracted with any other mood stabilizer or anything else. Just straight Prozac, just like it was straight Zoloft. So she prescribes Prozac 10mg for the first four days and then increase it to 20mg if tolerated. This is November 22nd that Lindsay says she starts Prozac.

• 9:25Speaker 00

  She's on Prozac and Nurse Julie also still says you can take the Ativan when you have severe anxiety. But the plan is, let's still taper off the Ativan, right? And let's move towards something like Boost Bar, which is not a benzo. It's anti-anxiety medication, much safer. Well, I don't want to say safer, but much less risk of dependency. That same day, November twenty second, twenty twenty two, Lindsay writes in her Tree of Life journal.

• 9:51Speaker 01

  Why is it called Tree of Life? Just the

• 9:53Speaker 00

  Yeah, it's like a tree of life.

• 9:54Speaker 01

  The name is on there?

• 9:56Speaker 00

  Affirmations, I am calm, I will remain calm today, there is nothing that needs to be on my mind. The weight is lifted from my mind, I will sleep tonight. Julie also sets up talk therapy with Lindsay with Letitia Dukes. But the same day that all of this is happening, Julie gets a message from Lindsay on MyChart, which is how she talks to her. It's like a provider to patient communication platform. And it reads, hi Julie, this is Lindsay Clancy. I'm sorry to contact you like this, but when you have a minute, can you please call? So Lindsay in her talk, and Lindsay expresses concern about starting the Prozac. They have a conversation, Lindsay states to Julie that, okay, fine, I will be starting the Prozac. But a few days later, Lindsay tells her that she doesn't like the Prozac.

• 10:41Speaker 00

  Julie testifies, she wasn't tolerating the Prozac, so we had a conversation about stopping the Prozac. She was having a really hard time sleeping, so I gave her a one-time dose of Ambien. Ambien is a very strong sedative for usually very severe cases of insomnia, but this is a one-time dose. But I think a lot of people just see Ambien on a list of medications and are like, oh, my God, Ambien on top of the benzos, it's a lot. And I'm not saying that her list of medications is not a lot, but it is a one-time dose. The next day, November twenty third, twenty twenty two, Lindsay journals, I slept well last night, I will sleep again tonight. Today will be a great day, I will go back to work on Sunday, I will thrive, I can feel like myself again.

• 11:25Speaker 00

  I'm grateful for Sue, Patrick's mom, who is always listening and trying her best to help me. Kids are sleeping great for Pat, Pat is handling nighttime stuff. I'm grateful for Julie for making a plan for me. A big thing is, I feel disconnected with myself, time, reality.

• 11:43Speaker 00

  I think going back to work will help with that. After Lindsay stops Prozac, after reporting to feel, quote, disconnected out of its spacey, Julie Paul prescribes Remarin, which is an antidepressant with very significant sedating effects. So it more so can help with sleep and anxiety. A lot of people report getting deep sleep with Remarin, though a side effect is feeling a bit groggy in the mornings, but Julie Paul also prescribes Klonopin. Klonopin is another benzodiazepine, but it's a much longer acting benzo compared to Ativan. And it appears that there is kind of like a less risk of dependence there.

• 12:26Speaker 00

  This is where people think it starts getting reckless. So when you have a benzodiazepine prescription and you get another one to replace it, you're not turning in your previous benzos. You still have them, you're supposed to have compliance, the patient has to show compliance of like, okay, I'm just gonna switch, right? But they think there's too many benzodiazepine prescriptions going out nonstop. And this is just one of the many that's going to continue, just different forms of benzodiazepines. So we're switching from Ativan to Klonopin. Now Julie Paul does argue that she wanted to switch to Klonopin because Ativan was giving Lindsay rebound anxiety. So when it wears off, the anxiety comes back tenfold, which makes her wants to take more Ativan probably. So Klonopin, it has a longer half-life.

• 13:11Speaker 00

  It's a, you know, you're not gonna feel as much of that rebound anxiety as what people report. So she wants to replace the Ativan with Klonopin. Lindsay reports that with the Remarin and Klonopin together, she did sleep on and off until about three forty-five AM, which isn't great, but it seems like this is better than what she's been dealing with. Lindsay asked Julie Paul if maybe she should up the dosage of the Remarin, so not the benzo, the, you know, Remarin, the antidepressant. She's like, would that help with sleep because it's an antidepressant with, you know, sedative effects, sedating effects, right? Julie Paul gives her the okay, let's trial and up dosage of Remarin,

• 13:49Speaker 00

  which does end up helping Lindsay sleep, but she reports that she's felt super disconnected with herself and reality. And this is again, a very common report for people with Remarin on Reddit that I could find. And she said that it was a very scary feeling. So Lindsay asks after two nights if she can stop the Klonopin, which Paul approves. So next day, we've stopped the Klonopin. Lindsay has a full panic attack. Okay, Julie Paul instructs her, take the Ativan. So stop the Klonopin, take the Ativan. And again, Klonopin is prescribed as needed, so these are both benzos, but like, don't take the Klonopin, take the Ativan. And she's like, go for a run, because running always helps Lindsay with regulating her anxiety. Julie also suggests partial hospitalization programs,

• 14:34Speaker 00

  but she says that Lindsay told her it, it didn't feel like it was gonna work logistically for her and her family. But this is the first time that we see a provider see that Lindsay's situation may need more intensive treatment than just normal outpatient medication appointments and therapy sessions. Then there's Letitia Dukes. Letitia Dukes is a therapist, so she's not a prescriber, which also means, I don't think, I think she might have been recently added into one of the lawsuits. But she is, she's not dealing with the medications, she is aware of the medications, she also works for South Shore, that's why Julie Paul recommended her. She's aware of the medications, but mainly this is talk therapy, cognitive behavior therapy, CBT therapy, right?

• 15:14Speaker 00

  Duke says her presenting concerns were anxiety, lack of sleep, depression symptoms, a frequent passive SI, thoughts of wanting to no longer exist, you know? At one point, this is where I think like the Commonwealth really is not doing itself a favor. Um, I do think the Commonwealth did a shit job at even preparing these prescribers for testimony.

• 15:39Speaker 01

  Okay, how so?

• 15:41Speaker 00

  They just like, I mean, none of them really know how to answer questions in a way that is, seems favorable to the jury. It just, a lot of people keep saying like the Commonwealth is doing the defense's job. And I would have to agree at certain points because it's just, just their lawyering does not seem that great. At one point, the Commonwealth, this is their witness, okay, a very important witness at that. The Commonwealth asks Letitia Dukes, as far as your role as a social worker, do you often get into the weeds with patients about their medication? Letitia Dukes is like, I'm not a social worker, I'm a mental health counselor, but yes, I typically have an overview of medications, but I don't particularly get into prescribing or how to take medications.

• 16:24Speaker 00

  And again, this is just another example of like, this is your own witness, you don't seem razor sharp, what's happening? And this is what, we're only like a week or two into trial? Heading into December, Lindsay reports to Letitia Dukes that she has low mood and feels numb. Duke's notes, she was tearful when discussing her anxiety symptoms. She reported as far as passive thoughts were thoughts of not wanting to be here or no longer wanting to live, but no plan. December fifth, Letitia Duke says, she reported that over the weekend, she had a difficult weekend having intrusive thoughts about, um, wanting to, and she contacted Aspire Crisis Support, a hotline. She met with the clinician virtually and was told that she did not meet the criteria for inpatient treatment due to having no SI plan.

• 17:10Speaker 00

  She reports that she did not see signs of mania or signs of delusion or paranoia and no signs of psychosis. But according to Duke's notes, she also says, feels like she's going to die, but she doesn't care if she dies, feels like she's gonna die, but doesn't care. She then talked about how the meds she's on were not helping her sleep. Yesterday, she took Ativan due to intrusive SI thoughts. She was constantly worried something was going to happen to her children or something bad was going to happen to the baby. She reported she talks about her anxiety all the time with her mom, husband, and mother-in-law. Duke says that Lindsay reported being uninterested in topics from friends, lack of interest in conversations.

• 17:49Speaker 00

  Lindsay told Duke that she just feels numb, lack of attention, confusion, she's only sleeping two to four hours a night, which is very alarming. Duke's notes that Lindsay's facial facial expressions show anxiety, fear, apprehension, and sadness. Duke's meets with Lindsay four times in December, but largely nothing explosive comes out of Duke's notes nor her testimony. And while Lindsay is meeting up with Letitia Dukes, Julie Paul transfers Lindsay's care to Rebecca Gelata. Julie Paul is leaving the practice and she's moving to New Hampshire, so she introduces Lindsay to Gelata. And she has been working at, Gelata has been working at this clinic for about two years. So this is all South Shore Hospital kind of system.

• 18:32Speaker 00

  Lindsay's first appointment with Gelata is November twenty ninth. And Gelata starts her on Seracel at twenty-five milligrams. So the plan originally was to just get Lindsay on there for maybe about four-week period for sleep and anxiety. But later Gelata starts considering it for longer-term mood stabilization, possible bipolar spectrum treatment. Now, side note, so far, most of the meds Lindsay has been prescribed are antidepressants and anxiety medications. Seracel is considered an antipsychotic medication, used typically to treat schizophrenia, bipolar disorder, but also major depressive disorder. So Gelata is saying like, when I started her on the Seracel, it was more so for the major depressive disorder.

• 19:13Speaker 00

  But then I'm like, wait, I feel like there could be an underlying bipolar disorder and maybe we need to take the Seracel for that instead. The bipolar conversation gets big here because Gelata straight up says she considers that Lindsay was bipolar. However, she does not meet the diagnosing, like the diagnostic criteria.

• 19:32Speaker 01

  Interesting. So same time, she's still seeing the first doctor through Telehealth the whole time? And are they double prescribing her the, the meds? Are they communicating? Do they know what's going on with each other?

• 19:45Speaker 00

  Gelata and Tufts never communicate, they do not get each other's records. Both of them argue that Lindsay was self-reporting to both of them what the other was prescribing. And they did not feel that there was any overlap in medications, is what they're saying.

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• 23:17Speaker 00

  Now, when Gelata takes the stand, a lot of people online don't like her. They don't like her and they don't like Tufts. Those are the two very controversial people. Tufts gets really defensive later, so that's one thing. Gelata is, I think people are kind of off put by her demeanor. She's incredibly smiley, almost has a playful energy to her. And maybe that could be her high-pitched voice, which I can relate to. And I'm also someone that likes to smile in very nerve-wracking, particularly high-risk situations where you do have to be very professional. But I think it's more so her tone and cadence. So she's asked, like, how do you spell your last name for the record? And again, she is someone.

• 23:59Speaker 00

  She's a nurse practitioner that specializes in helping people who are in dark places in life. So perhaps she's accustomed to talking in such a way that comes off super friendly. But, you know, when you are a witness on a murder trial and there are three young children, it just comes off maybe a little unsettling. How do you spell your last name for the record? J-O-L-O-T-T-A. What kind of training and education did you do in order to become a psychiatric nurse practitioner? I have my bachelor's degree from the University of Connecticut in Allied Health Sciences. And then I went on to get my master's actually in counseling psychology in 2013?

• 24:42Speaker 00

  Gelata is asked if a patient needs a higher level of care. Is it common to make referrals for those patients? Gelata does admit that it is pretty common practice, and that is like a huge debate online. Tufts, one and a half months into being a practicing psychiatrist, should she have referred Lindsay to someone that could provide the care that Lindsay probably needed? Gelata, nurse practitioner, should she have referred Lindsay to someone who could provide the care that she needed? Because you are also, again, not just talking about someone who might have an underlying bipolar diagnosis, you're talking about someone who is in that very sensitive postpartum time bracket. So a lot of things are happening.

• 25:25Speaker 00

  Gelata says when Lindsay came in, she expressed her concern about becoming dependent on benzodiazepines. And this is, this is like a huge thing. Okay, so the Commonwealth, they kind of hint at the fact that Lindsay was doctor shopping. And they think that Lindsay was doctor shopping for benzodiazepines. We'll get there. But as for benzodiazepine dependence, Gelata says she's concerned about taking Benzo. She had mentioned something called rebound anxiety. What that is, is once the dose wears off, your anxiety goes above your baseline once the dose of the benzodiazepine wears off. If she's taking it in the middle of the night, the next morning, she would feel more anxious. I was concerned about that. She was concerned about getting physically dependent on it because she had needed to take it for a number of nights.

• 26:10Speaker 00

  Gelata starts her treatment plan, which includes switching out the Ativan for Valium. So we go from Ativan. Julie Paul says, let's switch to Klonopin because it's a longer half-life, less, you know, rebound anxiety. Then she has a panic attack. Okay, back to Ativan. Now she's transferred to Gelata, and Gelata is like, you know what? Let's stop the Ativan and go for Valium. They're all different types of benzodiazepines. They do work differently, but they're all Benzos. She says the idea is Valium, kind of like the Klonopin, stays active in the body much longer than Ativan, so the rebound anxiety would probably be less with Valium. And again, Valium and Klonopin are different, so maybe she would react better to the Valium, you know? Now, Seracel is the huge conversation.

• 26:51Speaker 00

  So again, she first prescribes it more as a mood stabilizer for major depression. But later, Gelata thinks it could be possible bipolar spectrum treatment. Lindsay does not like the Seracel. The civil complaint attributes worsening intrusive thoughts and self-exit thoughts and auditory-type experiences to the period following Seracel. Now, I know a lot of people who think that Lindsay does have bipolar disorder too. They think it's strange that she did not react well to the Seracel, but this is also pretty common. Not every SSRI is going to react the same with every patient. Not everyone with bipolar two is going to react to Seracel in a certain way. But it's, I think the fact, the conversation is like, did we know that she had an underlying diagnosis or not? Right? Is more so the conversation.

• 27:32Speaker 00

  But Gelata is asked by the Commonwealth, what did Lindsay Clancy express to you as far as Seracel? Did she want to continue with that? No. Did she explain why? So she felt like when she took Remarin and Seracel together, she felt weighed down and exhausted. But her mind was still awake and alert, and she didn't seem to think that there was a benefit of being on it. And did she express to you a desire to want to get back to trialing Prozac? Both Lindsay and her husband expressed that that was their preference. Which, okay, this is where Patrick seems to get the most involved with Lindsay's treatment. He does meet up with Gelata, and he tells Gelata that his wife is not bipolar.

• 28:13Speaker 00

  So that is what Gelata reports in court, and there's a lot of conversation around that.

• 28:20Speaker 01

  Wait, Patrick tags along once that we know of and tells her that she's not bipolar?

• 28:26Speaker 00

  Yes, but he also tells her, like, all these medications, well, from his account is like, all these medications are turning Lindsay into a zombie. Like, can we just stop, like, and start fresh? Right? Like, stop all these medications and start fresh. Now, I will say to kind of point all aspects of this case, for someone that's not in healthcare, that could be a very reasonable request because it's like, gosh, these are so many prescriptions coming in and out. Like, can we just, like, please, slow down? It seems so rushed. Others are saying, well, his mother is a nurse, and Lindsay's a nurse. It's, you can't really just say, everyone stop for how long? And then I think more than that, though, I think people can see both ways for that. I think people don't like the fact that he said that my wife is not bipolar.

• 29:10Speaker 00

  So December 6, Lindsay comes to see Gelata with Patrick. And the Commonwealth asks Gelata, now, when you met with Lindsay and Patrick on December 6, did she or did they report why Patrick was there? I don't recall if they indicated why he was there. I understood it to mean he was there to provide collateral and support for her. Collateral being extra information. So this is also another huge thing. Reddington keeps pointing out to the other prescribers, especially Tufts, why didn't you call her husband? Why didn't you call Patrick Clancy? Why didn't you call her mom? You knew her mom came to stay with her because she was going through a rough time. Why didn't you call these people? Because you need collateral information, usually for psychiatric patients that you're concerned about, because they might not be reporting to you correctly.

• 29:55Speaker 00

  So it's better to get a third-party perspective to know exactly how they are behaving and what they are going through to add to the treatment. Now, a lot of healthcare professionals push back, saying, there's just not time. And to insinuate that you need to reach out to an adult's parents is very difficult and unfeasible unless you see some glaring red flags, which it does not appear that the clinical presentation in Lindsay's case was a glaring red flag. That is a huge argument, right? I don't know. But the Commonwealth continues with Gelata. Did you express to Ms. Clancy thoughts that you had about her diagnosis based on your interactions over the last few weeks? I did. And what was that? I discussed with her and her husband the possibility of potentially an underlying bipolar disorder.

• 30:39Speaker 00

  I based this on several factors, one of them being that she had... Such what we call in activating response to the Zoloft. It's unusual for somebody to describe taking Zoloft and then going forty eight hours without sleep and not being tired. So that raised my clinical suspicion a bit. And she had been, I would say, having difficulty tolerating other antidepressant medications that we had been trying to have her take since then. So again, I'm wondering if it's because potentially there might be an underlying, what we call a mood disorder, bipolar disorder. There's bipolar one and bipolar two, both have mania symptoms as part of the diagnosis. Bipolar one is usually more severe in that it's typically a patient might need to be hospitalized

• 31:23Speaker 00

  or it causes greater functional impairment. Bipolar two is a shorter duration and typically less functional impairment. And so while you noted that there were some concerns reported, did it rise to the level of diagnostic criteria for bipolar disorder? Not at that time. So there wasn't enough to diagnose Lindsay with bipolar disorder. Okay. And when you explain this to them, your thoughts about her reactions to the medications and these reported prior symptoms, did Patrick and Lindsay seem receptive to your diagnosis? I recall Patrick saying, my wife is not bipolar. Lindsay looked at me and she did not say anything. Were you able to get any more specific information from Patrick during that meeting? Not what he said particularly, but did you get additional specific information that

• 32:07Speaker 00

  kind of helped you assess whether you would change your diagnosis at that point? No. Patrick tells Gelata that Lindsay keeps waking up with panic symptoms. And she describes panic symptoms are racing heart, intense fear. Those are panic symptoms, sudden rushes of intense anxiety that seem to come out of nowhere. And Patrick later reports about Seracel. That was really when Lindsay's big spiral started. She started to lose a lot of weight and she became very depressed and she was having a really hard time. He says that this is around the time that she started telling him that she wanted to self-exit. Patrick says, quote, "It appeared she was affected very negatively and she's reporting that she was getting worse on the Seracel." So this is what Patrick is saying about the Seracel. Lindsay doesn't seem to like the Seracel either.

• 32:51Speaker 00

  In her civil suit, Seracel seems to be like the tipping factor as well. But people have some mixed feelings about Patrick being there and saying like, my wife is not bipolar. So it's just all sorts of conversations, but more on the Patrick conversation in the next episode, okay? But this is where it gets weird. The day after the conversation with Lindsay and Patrick about wanting to stop Seracel, the exact day after, Gelata prescribes Valium and Seracel, trying to ramp up to four hundred milligrams. So to give you an idea of what's going on, Lindsay and Patrick want to stop the Seracel. Patrick tells Gelata that his wife is not bipolar and Gelata's new plan is to stop the Seracel and retry Prozac. But the next day, Lindsay reports another awful night of sleep.

• 33:36Speaker 00

  However, Lindsay tells her that she did not sleep, but she does not feel tired. So again, this is very concerning perhaps, and this is maybe where Gelata feels the concern that Lindsay might be experiencing a mixed manic, hypomanic state instead of just anxiety and sleep issues. Prozac is held, Seracel comes back with rapid titration towards four hundred milligrams. So this twenty four hour window, we stop Seracel, retry Prozac, hold the Prozac, aggressively increase Seracel. This is one of the larger dosage movements in the timeline. So Lindsay was prescribed Seracel initially, November twenty nine thirtieth at twenty five milligrams. So now we're ramping up to four hundred, three hundred milligrams.

• 34:20Speaker 00

  Oh, and then also another thing is that it would appear that they're moving from normal Seracel to XR, extended release, which means now instead of Seracel lasting four to five hours, it's going to become eight to twelve hours in Lindsay's system. Gelata says that she increased the Seracel because I recommended one hundred on day one, two hundred on day two. So this is like, I don't know on a medical standpoint if this is rapid, but it just felt rapid to me as a layperson who has no medical knowledge. Day two, two hundred milligrams, day three, three hundred milligrams, day four, hitting that target number of four hundred milligrams Seracel. This is, she says, the manufacturer recommendation titration schedule to treat manic symptoms. Because again, I had shared with her, I think this is a mixed manic, hypomanic state.

• 35:04Speaker 00

  So that's what I was targeting. And when asked to describe a mixed manic state, she says, when a patient has symptoms of mania like poor sleep, no loss of energy, but they can also feel depressed, numb, self-exit thoughts. It's sort of like, it's a mixed state, it's a mixture of symptoms, and the presentation is clinically acute. Lindsay expresses wanting to get off Seracel. Gelata explains to her, as long as you're aware of the risks. I don't think you've been on Seracel long enough for it to have a positive benefit on your mood or anxiety, but if you have noticed benefit, the risk would be worsening of mood and anxiety upon stopping the medication. We also discussed tapering off the Valium, which I'm fine with. Being off medication might help you see where you are at baseline, but I do think

• 35:47Speaker 00

  you're experiencing significant and severe symptoms of postpartum depression that need to be treated. Gelata tells her, I acknowledge that medication alone is not always the best option for someone, but often it's part of the puzzle. Other treatments include counseling, support from others, exercise, healthy diet, yoga, relaxation techniques. I know this has been brought to your attention several times, but I strongly recommend a partial hospitalization program so that you can get started utilizing those treatment methods for relief. And Lindsay reports that she's at two hundred milligrams Seracel, but she's, still doesn't seem to like it. Now, in December, Gelata says that she wants to start seeing Lindsay in person. The Commonwealth asks, what did you recommend in person at that point? This was somebody who was communicating with me every day and I did feel that she had

• 36:32Speaker 00

  significant symptoms of depression, some mixed symptoms with mania, anxiety. I felt that her symptoms were severe and significant enough that I wanted to touch base with her weekly and I wanted to see her in person. Gelata later tells Reddington that sometimes it's better to have face-to-face actual meetings with a patient rather than just on the computer, which Reddington loves that point, right? And I will say that Reddington goes much easier on Julie Paul as well as Gelata. For a number of reasons, I think there's a lot of discourse online of why is he going so easy on the nurse practitioners and then going so aggressive on the psychiatrist? A lot of psychiatrists are backing up Tufts. It's a whole back and forth. However, I think with Julie Paul, she was not in Julie's Paul's care for a lengthy

• 37:16Speaker 00

  period of time and there was not that much medication movement for Julie Paul. And then as for Gelata, I think there is a defense strategy of not going too hard on her because the defense is arguing that Lindsay has bipolar disorder. And she was the only provider that was kind of seeing that. She's still named in the malpractice lawsuit, but more so to do with the Seracel. But I don't think that Reddington is particularly fond of Gelata. A lot of medicines are not fond of Gelata either. At one point Gelata is testifying, the Commonwealth asks her a question, Reddington objects, the judge overrules Reddington's objection and Gelata, maybe out of nervousness, she laughs. And Reddington is like, laughter coming from the witness judge.

• 38:02Speaker 00

  She's just like, it's a mess.

• 38:04Speaker 01

  So people mostly don't like her mannerism or how she carried herself.

• 38:08Speaker 00

  Yes. And then there are really a lot of debates. So when you watch the full trial, Lindsay and Gelata do communicate a lot through my chart.

• 38:17Speaker 01

  Okay.

• 38:18Speaker 00

  So there's a lot of back and forth communications. Some people think that Lindsay is the worst patient to have, so annoying, nonstop, right? Others argue there are times where Gelata is like, yeah, okay, we'll talk on Monday. Here are some resources for the weekend and it's just like hotlines and people are like, what the fuck? So there's a lot of like back and forth of, is this shit care or is this great care? And Lindsay is being unreasonable. I think it really depends on how much you like Lindsay Clancy, right? But there is a lot of debate about the constant benzoprecipations. Ativan, Klonopin, more Valium, like it just seems like a lot of benzodiazepines. Now, other than Gelata, none of the other providers state that they believed Lindsay could have been bipolar.

• 39:03Speaker 00

  But is that because Lindsay is not bipolar or is it because they were not looking for those specific signs? During the Commonwealth redirect for Tufts, asking about bipolar and Lindsay potentially having bipolar, the Commonwealth is asking Dr. Tufts, right? Because she's the one that prescribed the Zoloft. What are the types of questions you ask a patient to determine if they've experienced an episode of mania? Well, a lot of it is what I can see in a session. I might also ask about some of those symptoms like decreased need for sleep or racing thoughts or increased risk-taking activities. But even if they're reporting those things, I would have to really see it for myself to diagnose that. Which a lot of people argue that in her notes, she did say that Lindsay was having racing thoughts. She didn't really need the sleep, she wasn't sleeping, she went forty eight hours without sleep.

• 39:48Speaker 00

  So people are like, are these not the exact things that Lindsay told you? But the Commonwealth asks, and what would you see physically? I might see the person is talking very fast and it's almost impossible to interrupt their rate of speech. It might also be very loud, they might be hyperactive, not able to sit still, they might be yelling and jumping through one thought to another without any linear connection between the thoughts. Yeah, I guess that's probably what I would observe in terms of behaviors. Did you observe any of those behaviors with Lindsay Clancy? No, it was the opposite. What do you mean it was the opposite? The opposite of euphoria is dysphoria or depression. The opposite of hyperactivity is tiredness and fatigue. So in a way, it was the opposite of mania that I observed.

• 40:33Speaker 00

  Which again, people argue in a mixed manic state, you're going to have both present. But there's a lot of debate about even that.

• 40:46Speaker 00

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• 45:13Speaker 00

  Now, when it comes to Gelata, the one that did suspect underlying bipolar disorder. She says, if you were sure somebody had bipolar disorder, because if you put somebody on just an SSRI, like Prozac, like Zoloft, it can create a scenario where people are flipping back and forth between manic symptoms and depressed symptoms, or they're called rapid cycling. It's not that antidepressants or SSRIs are never prescribed in bipolar disorder, but you often would want to have a mood stabilizer onboard at the same time. December 7th, 9:48 a.m., Lindsay sends Gelata a message. Hi Rebecca, Rebecca Gelata. Last night did not go well at all. I took the Valium and melatonin and only slept from 9 to 1.

• 45:54Speaker 00

  Then around 2, I got desperate and took 25mg of Benadryl and only slept about one more hour. What can I do? I really need help. So this is another thing a lot of people have been pointing out. They say that with postpartum depression, a lot of people have pointed out that it's the fact that they are unable to get sleep because they have so many new things that they have to do in caring for a newborn. But this seems more so strongly insomnia. She cannot get sleep even when she has the time to sleep. Gelata says, patients can have insomnia because they're anxious, or because they're depressed, but typically they're exhausted, or they're tired the next day, and it really does affect them.

• 46:34Speaker 00

  If a patient has an underlying bipolar disorder, they could go on two hours of sleep and not feel tired at all, and that's unusual. So is that one of the signs potentially of a manic episode? Potentially, yes. December 7th, 10:33 p.m., Lindsay messages Gelata. No, the weird thing is, I don't feel tired at all. So just Seracil tonight? I feel like I'm going to panic without a Benzo with it. Would I be able to do Valium with Seracil? Gelata responds, if you're not sleeping well with the Valium alone, there's no need to continue it. And I will prescribe a short tape to get you off Benzos altogether. Because if you are not tired at all and had a significant reaction to Zoloft at 50mg, I'm concerned this is an underlying mood and bipolar disorder.

• 47:17Speaker 00

  I know you and your husband do not necessarily agree with that, but I'm going to send along this information to review. She sends Lindsay a list of symptoms of bipolar risk factors so she can refer to it. Reddington asks Gelata, so one of the things with the mania that you refer to, and that you talk about, is that excessive activity? Is that it? Excessive cleaning sometimes, right? Sometimes. Excessive exercise? Sometimes. Did you know that after Lindsay had Callan, that within a matter of a couple of weeks, that she ran a 5K? No, I did not know that. A lot of people think this is a crazy, like, often skipped-over conversation. I mean, some people argue they're runners.

• 47:58Speaker 00

  Others are saying like, that is kind of, with everything that we know about the case so far, feels like maybe she felt, because Patrick said she felt great the first 12 weeks, maybe she was in like a manic state. And usually after a manic state is a very depressive state, and then maybe it was after Zoloft, it was a mixed manic state with rapid cycling. Reddington says, and nobody wanted her to run the 5K, including Patrick. But she had to get out there and run, and did. Did you know that? I did not. Is that something that would be important to know? I mean, as far as whether or not a person is that manic stage where it's post-delivery, and that's a significant artifact, if you will, of exercising, right? It would have been something I would have considered.

• 48:40Speaker 00

  Side note, Lindsay went on a jog the morning she went into labor with Callan. So some people say, again, she's a runner, other people are saying like, it just seems like a lot. Reddington asks Gelata, do you know that she had lost over 15 pounds by that point? I was aware that she had lost some weight. I was not aware that it was 15 pounds.

• 49:00Speaker 01

  By what point, I'm sorry? From the beginning of the medication?

• 49:03Speaker 00

  I think, um, within the time of, I think, running the 5K. But there is a lot of rapid weight, weight loss.

• 49:10Speaker 01

  Oh, okay, okay, right after she gave birth.

• 49:12Speaker 00

  Yeah. Side note, Lindsay Civil Suit also argues that had the prescribers asked more information about Dawson's birth, her second child's birth, and she had told them more about it, those would have been critical indicators that would have, quote, alerted competent psychiatric providers to the risk of bipolar disorder and the potential for more severe postpartum psychiatric complications. According to Lindsay Civil Suit, it says, quote, Lindsay demonstrated significant activation in hypomanic behavior, including an extensive program of exercise, beginning only one week after delivery. She woke up every day before the children at 4 a.m., ran three miles, did spinning for 30 minutes, and then on the Peloton, and then 30 minutes of aerobics. Yeah.

• 49:55Speaker 00

  Yeah, her sister Allison also observed that Lindsay was like buying into this beach body multi-level marketing scheme. So she said that Lindsay is very sensible, but Lindsay was like purchasing a ton of products to resell for this beach body program of, you know, she started making these videos of her exercise routines, posting them on Facebook, encouraging her friends to join. So they're saying like, this is an option, that this is a hypomanic episode. After having the third child, and combined with her behavior after having Dawson, this should have immediately suggested to a competent provider that Lindsay may have bipolar disorder. And the biggest debate of all of this is from Tufts Notes from October 21st, 2021. So this is after Zoloft. Reddington has Tufts read her notes.

• 50:39Speaker 00

  No sleep last night, falls asleep after 40 minutes, heart racing, severe anxiety, worrying about kids, baby sleep, yawns, but not drowsy, not hyper, comma, pressured speech. Reddington is like, what was that? Not hyper what? Not hyper, not pressured speech is what I meant. I know it doesn't say not, but that is exactly what I meant. When did you see this, that you noticed that it did not say not? I don't care what it says, I know what it meant. Well, when you wrote this, you did not say not pressured speech. You said in the medical record, pressured speech. No. Does it say that?

• 51:19Speaker 00

  Yet the word not is right before, not hyper, comma, pressured speech. The two are following, but not. When you put down in the medical record, heart racing, severe anxiety, worried about kids, baby sleep, yawns, but not drowsy, not hyper, comma, pressured speech, that's what you wrote. She did not have pressured speech. Did you write that, doctor? I wrote that, but you're misinterpreting my note. Am I reading this correctly? And the jury will be able to look at it, that you put not hyper, comma, pressured speech. Did I read that right? Yes, but your interpretation is incorrect, as opposed to yours? That's all I have. Dr. Tufts is super defensive. She's practically huffing and puffing on the stand.

• 52:04Speaker 00

  And this pressured speech debate becomes huge. Pressured speech is rapid, frantic, uninterrupted way of talking driven by the urgent compulsive need to express racing thoughts. When someone has pressured speech, it's not even someone that talks quickly and talks a lot. It's not a yapper. It's some, you can't even get a word in. You can't even really interrupt them. It's like they're on a mission. But for Tufts, her notes, she is insisting that she meant not hyper, not pressured speech. But she wrote not hyper, comma, pressured speech. Now, one thing to note is that later the Commonwealth asks her about this. So this is like a whole other debate. A lot of Dr. Tufts' notes are checklist.

• 52:47Speaker 00

  Like the practice gives out these little checklists and little boxes that you just check off for each patients. I don't know if that would constitute like a malpractice suit, but it seems more so an opinion that netizens have made of like, what the fuck is that? However, I will say October 21st, 2022, Tufts does label Lindsay's speech in the box as appropriate. So she does check off the appropriate box.

• 53:10Speaker 01

  Oh, on the same one?

• 53:11Speaker 00

  Yes. So it could, like, I would, I would say that I'm leaning more towards she meant not pressured speech, just because that same day she does check off on the box, appropriate speech. However, I don't think that her reaction in front of the jury was great. I think it's really shitty note taking. Documentation of a patient.

• 53:34Speaker 01

  Dangerous too.

• 53:34Speaker 00

  Yeah. So while I am somewhat inclined to believe Dr. Tufts, I also think, what the fuck is that note? Why is that even up for debate? And what if this checklist didn't exist?

• 53:45Speaker 01

  Yeah.

• 53:45Speaker 00

  But even the checklist are kind of what the fuck, in my opinion. Like, why are we doing everything on checklist? It's just strange. But another person just comments, the fact that a doctor said, I don't care what it says during a murder trial is crazy to me. Others are just saying, I think that she had pressured speech. Holy moly, like this woman failed her. Others say she can't recall a question from the prosecution, but she recalls what her notes should have said? Others are like, a lot of healthcare professionals are saying like, this case is going to be used for the next 50 years to hammer in how important patient documentation is. And I think the only takeaway from this pressured speech, because I do see it kind of miscommunicated on social media a lot with people forgetting the checklist part.

• 54:29Speaker 00

  Because I do think that's a huge part of the story that's very relevant of whether or not Lindsay had pressured speech. But one thing that I will note is, I do find it perhaps a bit uncomfortable that she is listing her interest as people with, you know, with these perinatal mood disorders. And this is how she documents notes, when this is such a sensitive, vulnerable timeframe for people who had just given birth. There's a lot of reasons for a lot of things to go wrong psychiatry wise, but it's just a, that's the way you take notes? Is kind of bizarre to me. I think I take more extensive notes for like someone's dinner order if they asked me to order them something. It's just bizarre.

• 55:10Speaker 00

  But that's my opinion. I'm not a healthcare professional, nor am I a doctor by any means, so. And speaking of pressured speech, that brings me back to, a lot of people think that her notes were pressured speech. There's another mother who was going through postpartum, unrelated to this case. She had a potential undiagnosed bipolar disorder. And she shares her experience, not in court, this is on Reddit, right? And she was saying like, once I got back from the hospital after giving birth, I could not stop writing.

• 55:37Speaker 01

  Oh, they're saying Lindsay Clancy's phone notes app is pressured speech.

• 55:41Speaker 00

  Just like her intense documentation of everything. You know, because I think a lot of people are debating, and again, it's, that's why mental health is so hard, because you can't say, oh, well, depressed people don't do that. It's really hard to say, but a lot of people are arguing like, I don't know if someone who is dealing with major depression disorder is going to take extensive notes about everything they feel unless they are told to by a provider. And it doesn't seem like Lindsay was told to, at least initially. One person writes, like, I just kept writing. Tons of energy, pressured speech, no appetite, weight loss. I couldn't sit still. But she says, I simply could not stop writing. I wrote at every opportunity, even during breastfeeding. I went online, typed lengthy emails to friends. I didn't realize my friends would see the actual

• 56:25Speaker 00

  time I sent the emails. And some of them later told me that they were puzzled that I was writing such lengthy emails in the wee hours of the night. And we do know that Lindsay kept pretty intense notes about a lot of things, which we're going to go over all of those notes in the next part, where we go through not only the notes, but Lindsay's hospitalization in January, which has been heavily debated, as well as the overall conversation of the lack of coordination of care. But also how all of that seems to ramp up until January 24th. And what Patrick said happened January 24th, 2023, as well as his 60 Minutes interview. And why a lot of people don't believe what Patrick said. Let me know your thoughts. Stay safe and I will see you in the next one.

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