Postpartum psychosis is at the center of the Lindsay Clancy trial. What is it?

Lindsay Clancy, a 35-year-old former nurse, is currently facing trial in Massachusetts for allegedly murdering her three young children in 2023. According to court documents, Clancy reportedly strangled her children, who were five years, three years, and eight months old, before attempting suicide. She has pleaded not guilty to the murder charges, asserting that she was suffering from postpartum psychosis, a mental health condition.

Clancy’s defense team claims that during the incident, she was influenced by auditory hallucinations that instructed her to kill her children and herself. Meanwhile, the prosecution contends that the murders were premeditated.

This high-profile trial has brought significant attention to maternal mental health issues, particularly postpartum psychosis. Experts in maternal mental health emphasize that while the disorder is complex and understudied, it is also treatable.

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What is postpartum psychosis?

Postpartum psychosis is a severe but rare mental disorder affecting individuals who have recently given birth. Occurring in approximately one to two out of every 1,000 live births, explains Khatiya Moon, an assistant professor of psychiatry at the Zucker School of Medicine at Hofstra/Northwell. This condition is distinct from postpartum depression, which is more prevalent, impacting roughly one in five to ten postpartum individuals.

The symptoms of postpartum psychosis are diverse, Moon states, and may involve delusions, paranoia, repetitive or purposeless behaviors, and hallucinations, such as hearing voices or feeling nonexistent sensations.

Additional symptoms might include trouble with sleep, eating, or personal hygiene. “Obviously, when you become very preoccupied by various delusions, it can be hard to think about anything else,” Moon explains.

Patients with psychosis often lose “insight,” or the ability to recognize the need for medical help. “They can tell that something’s off, but they may not really understand what exactly is happening,” Moon adds.

What causes postpartum psychosis?

The exact cause of postpartum psychosis remains unidentified, as with many psychiatric disorders, according to Veerle Bergink, director of the Women’s Mental Health Center at Mount Sinai. Researchers suspect it may be linked to the dramatic hormonal changes during pregnancy or alterations in the immune system post-delivery, she suggests.

Studying this disorder poses challenges due to its rarity and the lack of formal recognition as a disease, which complicates funding efforts, Bergink notes. When it occurs, it is a medical emergency, making it difficult to conduct tests such as blood work or MRI scans. Symptoms can also fluctuate frequently, complicating diagnosis.

While postpartum psychosis can affect anyone, some groups face higher risks, Bergink says. Those with bipolar disorder have about a one-in-six chance of developing postpartum psychosis. Moon states, “For all my patients that have a known bipolar disorder, and they’re going into a pregnancy, I always talk to them about the risk of postpartum psychosis.”

How can it be treated?

Currently, there are no FDA-approved treatments specifically for postpartum psychosis. However, Moon points out that treatments for other types of psychosis may be applicable, including antipsychotic medications, benzodiazepines for sleep and anxiety, and lithium, commonly used for bipolar disorder. Some studies suggest electroconvulsive therapy (ECT), involving short electric shocks to the brain, could be beneficial.

Rapid identification of postpartum psychosis is crucial due to the increased suicide risk, Bergink mentions. Infanticide cases, although widely reported, are rare even among those with postpartum psychosis. “The way more prevalent catastrophic event is suicide,” she says.

With appropriate treatment, many individuals recover fully. “It is a very, very treatable condition,” Bergink confirms. “There are women who have this as a single episode in their lives. They get severely ill—and never again.”

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