Warning: Graphic content Lindsay Clancy’s murder trial has centred on the mental health issues the 36-year-old faced after giving birth to her third child. Defence attorneys for the Massachusetts labour and delivery nurse do not deny that Clancy strangled her three children — Cora, 5; Dawson, 3; and Callan, 8 months — before jumping from a second-story window of her suburban home in 2023. Instead, they contend that she is not criminally responsible because she was experiencing postpartum psychosis, a rare mental health condition. After Callan’s birth, Clancy had taken medication for mental health problems, according to her providers, and had sought help from several mental health professionals who testified this week. Prosecutors claim that Patrick Clancy’s descriptions of how he found his children and the methods his wife used to strangle them are evidence of “deliberate premeditation, extreme atrocity or cruelty, and the state of mind of the defendant.” Mental health issues are the most common complication of pregnancy and parenting, affecting as many as 1 in 5 women in the United States during pregnancy and the year after birth. They are also the leading underlying cause of pregnancy-related death in the United States, but they are often overlooked. These conditions — and their treatments — vary widely. Postpartum psychosis Postpartum psychosis ranks as one of the rarest and most severe mental health disorders associated with childbirth. It affects up to 2 of every 1,000 women after childbirth. If a mother has postpartum psychosis, she needs treatment right away: Studies show that, untreated, it carries a 4% increased risk of infanticide and a 5% increased risk of suicide. Symptoms Symptoms typically emerge between two weeks and a year after birth, although about 90% of episodes happen within four weeks. They can include irritability, moodiness, restlessness, insomnia and delusional beliefs. The mother may also have auditory or visual hallucinations that drive her to harm herself or the infant. Most women with postpartum psychosis develop manic and depressive symptoms that can come close together or overlap. They may have confusion; dysregulation, in which a person struggles to manage emotional or behavioural responses; or depersonalization, a dissociative state in which a person feels detached from their body or identity. Women with this diagnosis often do not recognize that they have a problem because they are disconnected from reality, a 2024 study found. It’s unclear what causes it. There is probably a genetic component, as it’s more likely in people with a family member who’s had it. Women with bipolar disorder are also much more likely to develop it. Biological triggers can play a role. People who report a history of sleep loss that triggers mania are much more likely to develop postpartum psychosis, and a person with a previous experience with postpartum psychosis is more likely to have it again. Acute, severe symptoms typically last two to 12 weeks. With treatment, complete recovery depends on several factors and generally can take six to 12 months or longer. This condition can be hard to identify, studies show, because symptoms wax and wane, and women may not report them to relatives or healthcare providers. “I think, in a way, the name doesn’t help us. It’s called postpartum psychosis, but it’s actually a mood disorder,” said Dr. Lauren M. Osborne, vice-chair of clinical research in the Department of Obstetrics and Gynecology at Weill Cornell Medicine. Psychiatric disorders are generally divided into mood disorders and psychotic disorders, Osborne said; postpartum psychosis is a mood disorder, in which mood symptoms accompany psychotic symptoms. “The psychotic symptoms that we see are often less obvious than in other psychotic illnesses. So people will often have delusions, meaning a fixed false belief in something. They will less often have something like hallucinations, seeing things, hearing things, and it has a kind of waxing and waning course. A woman can appear to be OK one minute and really not OK the next minute, so it’s hard to catch,” Osborne said. High anxiety, difficulty sleeping, stress and overwhelming concern for the infant can be common, depending on how impairing they are and how long they last, but the larger picture matters, reproductive psychiatrist Dr. Nicole Leistikow said. “Psychosis has this specific definition, but in the postpartum context, it can be much more subtle and difficult to discern than it might be outside of that context,” said Leistikow, who is the clinical director of the Johns Hopkins Reproductive Mental Health Center. Leistikow noted that there are good screening questions for postpartum depression and anxiety in the perinatal context. “But we really don’t have a tool that says ‘boom, you have postpartum psychosis.’” Treatment Treatment often requires hospitalization. Ideally, the mother would be admitted with her baby, but mother-baby treatment units are uncommon in the U.S., which can be an obstacle to care, Leistikow said. “What new mother is willing to risk separation from her infant? That’s incredibly scary and makes it much more difficult for women to come forward.” Hospital care typically involves counselling, close monitoring and medication based on symptoms. Second-generation antipsychotics, such as olanzapine, quetiapine and risperidone, are often paired with mood stabilizers such as lithium. Mothers may also receive short-term benzodiazepines to help with sleep and severe agitation. Experts advise families to learn about the condition so they can recognize warning signs. Although postpartum psychosis is rare, Leistikow said, families can take steps to prepare, particularly if the mother has a history of mental illness. Connecting with a provider during pregnancy can help optimize mental health before delivery and establish a baseline. Planning for sleep after birth also matters. “Let’s proactively make a plan with another responsible, loving, caring adult to help with infant night feedings, so that we’re going to make it more likely than not that you can get a four-to-six-hour chunk of sleep, plus some additional sleep,” Leistikow said. “Now we have a whole support network watching for things like insomnia, where a mother is given the opportunity to sleep but still can’t sleep. And if that happens, we want to have postpartum psychosis on our differential, and we want to interrupt quickly to find out what’s happening and see how we can treat the insomnia before that spark becomes a fire and becomes harder to treat.” More common postpartum mental health issues can also strain parents. Maternal depression Maternal depression is also called postpartum depression, peripartum depression, perinatal depression or just PPD. It is not a separate diagnosis in the DSM-5, the manual that psychiatrists use to identify mental health conditions. Instead, it is classified as major depressive disorder. Maternal depression can last weeks or months and can arise during pregnancy or after birth. It can bring sadness that dominates a person’s thoughts about herself and her child. Postpartum depression is common, research shows, affecting about 1 in 7 women after giving birth. Symptoms Symptoms can be mild or severe and can make it difficult to find joy, concentrate or connect with the baby. Treatment Treatment depends on symptom severity. Options include talk therapy; support groups; Zurzuvae, the first oral treatment for postpartum depression approved by the U.S. Food and Drug Administration, or anti-anxiety or antidepressant medicines such as Zoloft, Prozac, Cymbalta, Pristiq, Elavil and Tofranil; and lifestyle changes such as getting more rest, walking and eating a healthier diet. PPD does not typically resolve on its own. Even with treatment, antidepressants take a few weeks to work, and not everyone responds the same way. Maternal anxiety Postpartum anxiety is also common and often overlaps with maternal depression, affecting about 1 in 5 women. It can leave a new mother feeling anxious, nervous or worried all the time, with feelings that become overwhelming and affect her ability to function. Symptoms Symptoms can include sleeplessness, extreme worry about the baby or childbirth, restlessness and a racing heartbeat. This anxiety can also happen with obsessive-compulsive disorder. Treatment Maternal anxiety is treated with cognitive behavioural therapy, support groups and medication such as selective serotonin reuptake inhibitors, or SSRIs, including sertraline and escitalopram. Cognitive behavioural therapy can teach the woman to identify emotions and change thought patterns. ‘Baby blues’ The “baby blues” are not considered a disorder. The phrase describes a common, temporary condition that research shows affects about 80% of people who give birth. Symptoms A parent with baby blues may have trouble controlling strong emotions, especially sadness, anger, frustration or anxiety. She may cry more often and struggle to sleep. Treatment The condition usually is short-lived and resolves without treatment. Problems are often overlooked Although common, postpartum mental health issues are often overlooked, Osborne said, speaking generally about conditions in the first year after birth and not about the Clancy case, with which she has no affiliation. The American College of Obstetricians and Gynecologists recommends screening women at least twice during pregnancy and once after birth for anxiety and depression, the most common disorders. “It’s a challenging thing logistically to do, and that’s really only going to catch people who currently have symptoms,” Osborne said. “It’s not going to catch people who are at risk of symptoms. And the problem, in a lot of cases, comes in the postpartum, when the standard of care is you see your OB once at six weeks postpartum, but the highest-risk period is six to eight weeks after giving birth. Except for this one snapshot of time, we’re just missing a lot of people, even if we do screen appropriately.” By Jen Christensen, CNN If you or someone you know is in crisis or struggling with mental illness, here are some resources that are available. Canada Suicide Crisis Helpline (Call or text 988 or visit 988.ca) Centre for Addiction and Mental Health (1-800-463-2338) Kids Help Phone (1-800-668-6868) If you need immediate assistance call 911 or go to the nearest hospital.
