What could drive a loving mother to strangle her three children? Psychologists reveal warning signs of devastating condition that all women and their partners need to know – as Lindsay Clancy murder trial grips the world

Lindsay Clancy, 36, stands accused of an almost unimaginable crime – murdering her three children, aged five, three and eight months, before trying to take her own life.

The trial, which began three weeks ago, continues to spark shock and heartbreak on both sides of the Atlantic, as witnesses recall the months leading up to the tragedy in front of a Massachusetts judge and jury. 

The family’s lawyers argue she was not responsible for her actions. 

Instead, Clancy – who is paralysed from the waist down after jumping from a second-floor window in an apparent suicide attempt – was in the grip of postpartum psychosis, a frightening condition which triggers delusions, hallucinations and violent mood swings post-birth.

They say the ‘wonderful caring mother’ began hearing voices after her youngest child’s birth that ordered her to kill her children and herself, and told the court the nurse was ‘not herself’ in the months after birth.

While postpartum psychosis is rare, affecting around one in 1000 new UK mothers, experts say it can seemingly appear out of nowhere – and is often difficult to spot. 

Alarmingly, around half of women who develop postpartum psychosis have no previous history of mental illness. 

And experts speaking to the Daily Mail say that, when left untreated, or dealt with inappropriately, tragic cases like that of Clancy are an unfortunate eventuality. Here, they reveal the disturbing – yet fascinating – impact of the devastating condition. 

It’s not just ‘the baby blues’ 

Most new mothers know the feeling – sudden mood swings, crying, becoming irritated at your partner for every little thing. 

The ‘baby blues’ sets in about two to three days after delivery for about 80 per cent of new mothers amid a lack of sleep and stress of caring for a newborn. 

‘This is a very transient experience for the majority of women that’s possibly related to the drop in hormones, although there isn’t a great deal of evidence to prove this,’ explains Dr Carmine Pariante, a psychiatrist and professor of biological psychiatry at King’s College London.

But about one in eight new mothers, 85,000 each year, go on to develop postnatal depression, which can last months or even years after birth. 

Unlike the more mild mood changes of the baby blues, women with the condition can suffer sadness, feelings of worthlessness and excessive worrying, along with classic depression symptoms like appetite changes and a lack of motivation. 

‘It features many of the classic signs of depression, but there’s an added layer of distress because many women feel tremendous guilt about being unable to look after the baby,’ says Professor Pariante.

It’s unclear exactly what causes postnatal depression but pregnancy complications, a personal or family history of depression and relationship struggles can raise the risk. 

Postpartum psychosis, however, is rarer, affecting one in every 1,000 mothers – around 1,300 every year.

Doctors say what separates postpartum psychosis from the more common postnatal depression is that it can deteriorate rapidly, leaving mothers at immediate risk of harming themselves or their children if untreated. 

Postpartum psychosis is a sudden psychiatric emergency. Mothers lose touch with reality, suffer hallucinations, mania, paranoia and rapid mood swings. 

In many cases, like Clancy’s, hallucinations and delusions can tell mothers to hurt themselves or their babies. 

‘Symptoms usually begin between a day to two weeks after birth, although they can follow a period of depression, later down the line,’ says Professor Pariante.

‘Often a mother will start acting very unlike herself. For instance, sometimes a woman will have delusions that tell them their child is possessed by the devil, or they are, which can result in very tragic outcomes.’

Professor Pariante says that, although child death related to postpartum psychosis is rare, ‘it does happen, and it can be really scary’.

On Tuesday, Clancy’s former mother-in-law told the court that Clancy admitted she’d had ‘thoughts of harming the children’ a month before the tragedy.

Clancy’s mother Paula Musgrove also testified that her daughter had said ‘this isn’t me, I’ve never been like this before’. 

Ms Musgrove added: ‘And I would agree, because she wasn’t.’

The mothers that are most at risk

There isn’t one single trigger of postpartum psychosis. It can be brought on by a combination of severe sleep deprivation, drastic hormone fluctuations and a history of mental health conditions, especially bipolar disorder. 

‘Women with bipolar disorder are at much higher risk of the condition,’ says Professor Pariante. 

‘Around one in two women with bipolar will develop postpartum psychosis. But the condition is often undiagnosed, so the psychosis appears to come out of nowhere.’

Bipolar disorder is a mood problem affecting around a million people in the UK, characterised by periods of depression and mania. 

‘If a person has only experienced depression before they give birth then the extreme mania they suffer immediately after birth comes as a surprise – but it’s actually indicative of underlying bipolar disorder,’ says Professor Pariante. 

Experts believe postpartum psychosis is most common in women giving birth to their first child, and there’s a 30 to 50 per cent chance of it recurring in subsequent pregnancies. 

Sleep disruption can play an important role because it can alter the brain’s regulation of key neurotransmitters involved in mood, perception and thinking, while also disrupting normal brain function. In vulnerable women, experts believe this may trigger the onset of psychotic symptoms.

The mistake of ‘overmedication’

After the birth of her youngest child, Clancy repeatedly sought medical help as her mental health deteriorated. Instead of receiving specialist inpatient care, her defence alleges she was prescribed 13 different psychiatric medications by multiple doctors over the following four months.

Defence attorney Kevin Reddington said the result was ‘a horrific overmedication of drugs that caused homicidal ideation [and] suicidal ideation’. 

Providers in the lawsuit filed by the Clancys have filed motions to dismiss. The Daily Mail has reached out to those providers for comment. 

South Shore Health, one of the providers implicated, told the Daily Mail in a statement: ‘South Shore Health cares deeply about and prioritises the safety of our patients and their families and always strives to provide excellent care. 

‘Given that this matter is now in litigation, we cannot comment on the specific allegations contained in the lawsuit.’

The lawsuit claims the list of drugs included three benzodiazepines – Klonopin (clonazepam), Valium (diazepam) and Ativan (lorazepam) – all of which are used to treat anxiety and insomnia. 

Clonazepam has become well-known in recent years for its role in a number of high-profile deaths.

While it wasn’t mentioned in the toxicology report following the death of popstar Liam Payne, police found a packet of the pills – dubbed ‘super Valium’ – in his hotel room.

Tragic child star Hayden Panettiere, who is thought to have died from a drug overdose this month, had previously spoken of her addiction to clonazepam and is believed to have been taking prescription medication at the time of her death.

Both Fleetwood Mac legend Stevie Nicks and Girls creator Lena Dunham have spoken publicly about their clonazepam addictions.

The drug is 20 times more potent than diazepam, and remains in the body for longer than both Valium and Xanax (alprazolam). 

Experts have recently identified a rise in the misuse of the drug in the UK, with prescriptions increasing by 12 per cent in 2023.

Other medications prescribed to the mother included those used to treat mood disorders such as depression, including Zoloft (sertraline), amitriptyline, Remeron (mirtazapine), Prozac (fluoxetine) and trazodone. 

The lawsuit alleges she was also prescribed mood stabilizers Lamictal (lamotrigine) and Seroquel (quetiapine fumarate), as well as anti-anxiety drug buspirone, the sedative Ambien and hydroxyzine, an antihistamine used for anxiety or insomnia. 

‘The multiple medications that Lindsay Clancy was taking is called polypharmacy, or a medication “cocktail,”‘ Dr Carole Lieberman, a forensic psychiatrist in Beverly Hills, told the Daily Mail.

Dr Lieberman explains this is generally discouraged ‘because it causes too many side effects that multiply with the addition of each medication, and some medications cancel out the effect of others’.

These medications can lead to a long list of side effects such as nausea, insomnia, headaches, low sex drive, drowsiness, dizziness, weight gain, tremors, diarrhoea and high heart rate. 

Ambien specifically lists aggressive behaviour, abnormal thoughts and behaviour, agitation, visual and auditory hallucinations and suicidal thoughts or actions as rare side effects.

Dr Allen Masry, psychiatrist and medical director of All Solutions treatment centres, notes combining ‘excessive amounts of sedating medications may result in extreme drowsiness, difficulty concentrating, memory problems, slow response times, dizziness, or increased agitation’.

‘The most challenging part of managing patients with severe postpartum psychiatric illness is determining if deteriorating symptoms are primarily due to medication side effects or a rapid progression of the underlying illness,’ he told the Daily Mail. 

‘Medication should be simplified when appropriate, and close follow-ups should be provided.’ 

He also warns stopping any psychiatric medication suddenly can lead to withdrawal symptoms like dizziness, headaches and tremors.

Combining multiple psychiatric medications can also increase the risk of serious adverse reactions. 

For example, taking more than one medication raising serotonin levels – including SSRIs such as Zoloft and Prozac – can, in rare cases, trigger serotonin syndrome.

The potentially life-threatening condition occurs when serotonin levels become excessively high, overstimulating the nervous system and causing symptoms including agitation, tremor, muscle rigidity, fever, a rapid heart rate, diarrhoea and confusion.

Experts also warn prescribing multiple psychiatric medications at once, or making frequent changes to doses and drug combinations, may increase risks of serious side effects. 

In susceptible patients, certain medications can contribute to agitation, mania or psychotic symptoms. One Yale review estimated about 8 per cent of psychiatric admissions were linked to antidepressant-associated mania or psychosis.

Stopping some psychiatric medications abruptly can also be dangerous. 

Antipsychotics, for example, should generally be tapered under close medical supervision. Sudden withdrawal can trigger a rebound of psychotic symptoms.

It is important to note medication remains a cornerstone of treatment for postpartum psychosis. 

Current guidelines recommend urgent hospitalisation – preferably in a specialised mother-and-baby unit – with treatment typically involving antipsychotic medication.

Red flags mothers and partners need to know 

‘One of the biggest misconceptions is that severe postpartum mental health concerns are always obvious,’ said Rachel H Tribble, a licensed clinical social worker in Florida.

‘Symptoms can develop gradually and may wax and wane, which makes them more difficult to recognise.’

She said warning signs include severe insomnia or a reduced need for sleep, confusion, dramatic mood changes, paranoia, hallucinations, delusions and behavior markedly out of character. 

‘Family members often notice subtle personality changes before the mother recognises them herself,’ she added.

Clancy’s lawyers claim she experienced anxiety after the births of her first two children and that her symptoms returned after the 2022 birth of her youngest child. 

According to a lawsuit filed against her psychiatrist, by December she was experiencing panic, emotional numbness, racing thoughts, suicidal ideation and an overwhelming fear ‘something awful might happen’.

The lawsuit alleges on January 24, 2023, she heard a ‘compelling and unrecognisable singular male voice’ telling her she should die and that her children would suffer if she was gone. Later that day, prosecutors say she killed her three children.

‘It’s important to remember that postpartum mental health conditions don’t always look like sadness,’ Rebecca Boone, clinical counsellor and director at Woodlands Grove Recovery Campus, told the Daily Mail.

‘A mother may appear intensely anxious, emotionally numb, unable to sleep even when exhausted, overwhelmed by guilt, detached from her baby, or consumed by intrusive thoughts that feel frightening or out of character.

‘If someone begins expressing bizarre beliefs, hearing or seeing things that aren’t there, becoming severely confused, or losing touch with reality, they need immediate emergency evaluation.’

If you or someone you know needs help, call NHS 111 and say you need urgent mental health support, or call the Association for Postnatal Illness on 0207 386 0868 (lines are open 10am-2pm, Monday to Friday).