MA - Lindsay Clancy, Strangled 3 Children in Murder/Suicide Attempt, Duxbury, Jan 2023

[spicyrock]

I think a lot of psych meds can cause it, particularly if stopped suddenly.

Source: My sister-in-law had to stop one of her meds cold turkey when she got pregnant. She was psychotic for ten days.

Did it happen to be an antipsychotic? That could definitely bring on psychosis. But that’s in a person who already experienced psychosis, I would think?

LC was taking seroquel for something. I wonder when that was discontinued?

 

[BrownRice]

There was a woman here in Utah a few years ago that had severe PPD. This was her 5th baby and she had no problems previously. They were trying to get her help, but it didn’t happen fast enough. They went to a dinner at her parents home, and left because she became upset. She was flipping out, so her husband pulled over on the freeway. She jumped out of the car and ran on to the freeway in front of a semi. It happened so quickly, there was no way to stop her. Her husband started a program in her name to help others. It is a diagnosis that is hard to understand and is not the same in everyone.

The Emily Effect | Salem UT

The Emily Effect, Salem, Utah. 12,935 likes · 7 talking about this · 5 were here. Join us in our movement to #EndTheStigma and help raise awareness for moms who suffer from perinatal

www.facebook.com

Woman Hit By Semi On I-15 Identified As Mother Of Five | Gephardt Daily

Emily's Story - The Emily Effect

The story of Emily Cook Dyches, the inspiration for The Emily Effect, an organization dedicated to raising awareness for maternal mental health problems.

theemilyeffect.org

That’s a very sad story. I looked at the website her husband created and it gives an overview of the period from the baby’s birth to the accident.

 

[iamshadow21]

Did it happen to be an antipsychotic? That could definitely bring on psychosis. But that’s in a person who already experienced psychosis, I would think?

LC was taking seroquel for something. I wonder when that was discontinued?

I don't know what medication it was. I know she's on Effexor now (that's the one that really knocked me around) and I think she has Seroquel, but I think it's for night terrors or something? I'm not sure. She's on something for night terrors. We're not that close, and I don't like to pry. This thread does make me wonder if it's been her only moment of psychosis, though. I know for at least one of her postpartum periods, she was inpatient somewhere for over a month with other mothers. They could have their babies with them during the days, and the babies would be taken home at nights by their partners/other family. It's not something I would ever raise with her. She's emotionally very closed off. I know the times she has been in crisis, even my brother hasn't known about it until she literally can't hide it any more. She masks with everyone, all the time. I can understand it, knowing what I do about her past, but it makes it very difficult to form a relationship with her.

 

[spicyrock]

Ps, I’m still also thinking about lamictal. I’m intimately familiar with that one, lol. And even though it is prescribed for other things I wonder, bc it is a very common bipolar med. Bipolar doesn’t necessarily or even usually come with psychosis. Lots of people have mania or hypomania and depression without it. So I wonder if she had a more low-key (relatively!) bipolar than mine, maybe one heavier on the depressive side, bipolar 2. Maybe she had taken lamictal long term for maintenance, perhaps with an antidepressant add on since she would have had the mood stabilizer in place.

In that scenario I think PPD could be very dangerous. I wouldn’t be surprised if psychosis came- you can have psychosis in depression as well as in mania. But ime that psychosis still takes away your insight.

 

[GoBuckeyes]

Did it happen to be an antipsychotic? That could definitely bring on psychosis. But that’s in a person who already experienced psychosis, I would think?

LC was taking seroquel for something. I wonder when that was discontinued?

She was also taking amitriptyline.

 

[infinit]

Ps, I’m still also thinking about lamictal. I’m intimately familiar with that one, lol. And even though it is prescribed for other things I wonder, bc it is a very common bipolar med. Bipolar doesn’t necessarily or even usually come with psychosis. Lots of people have mania or hypomania and depression without it. So I wonder if she had a more low-key (relatively!) bipolar than mine, maybe one heavier on the depressive side, bipolar 2. Maybe she had taken lamictal long term for maintenance, perhaps with an antidepressant add on since she would have had the mood stabilizer in place.

In that scenario I think PPD could be very dangerous. I wouldn’t be surprised if psychosis came- you can have psychosis in depression as well as in mania. But ime that psychosis still takes away your insight.

It's a strange one, it does seem to be used by some for treatment for drug resistant depression, although as of 2013 it seems there was little evidence for doing this.

Lamotrigine for Major Depressive Disorder Is Inappropriate

Lamotrigine is an important option in bipolar disorders. However, many clinicians also use it in patients with a (unipolar) depressive disorder who have not responded adequately to conventional antidepressants.

www.psychiatrictimes.com

 

[spicyrock]

It's a strange one, it does seem to be used by some for treatment for drug resistant depression, although as of 2013 it seems there was little evidence for doing this.

Lamotrigine for Major Depressive Disorder Is Inappropriate

Lamotrigine is an important option in bipolar disorders. However, many clinicians also use it in patients with a (unipolar) depressive disorder who have not responded adequately to conventional antidepressants.

www.psychiatrictimes.com

Interesting article. The people I know with treatment-resistant depression have had every drug in the universe thrown at them, it seems to me. LC had a lot of antidepressant drugs thrown at her too (but only one SSRI- which again, makes me wonder about bipolar. But who knows, really. It’s just something I keep in the back of my mind, IANAD and we tend to see ourselves in other people). Maybe she had TRD.

I am still affected by the fact that she was trying to get help.

 

[spicyrock]

I find it a little nerve-wracking that this is the first time I’m hearing of this, because I am bipolar and I don’t remember once throughout my two pregnancies my doctor even mentioning postpartum psychosis or being questioned during any follow ups after that. It’s especially concerning because I didn’t see just a regular OB, I saw exclusively an MFM, who one would assume would have a great amount of knowledge of everything that could go wrong during a pregnancy.

And just fyi, I totally believe you since I did my own research after you mentioned this, so I’m not questioning you. I’m just rattled a bit. If a MFM treating a woman with an established bipolar diagnosis doesn’t seem concerned about PPP, I can only imagine all the women who could fall through the cracks.

That is alarming. I have read the statistic for how common PPP is, is one in a thousand. That’s actually a lot of women. This article from the UK NHS puts that number at one in five hundred- who knows how many women fall through the cracks at that rate.

Postpartum psychosis

Information on postpartum psychosis (psychosis after childbirth), with links to other useful resources.

www.nhs.uk

 

[spicyrock]

Someone spoke to this earlier and I think it’s important to me too- in the US, children have rights. Your five year old (example) has a right to live. You don’t have the right to kill a child just because he or she is yours. A defense of LC has to be measured against that. Doesn’t mean she can’t be found NGRI or that treatment isn’t the more appropriate option or that she doesn’t deserve compassion- but her children lost their lives because she took them. That matters to me.

 

[GRT]

I couldn't disagree more. MOO, of course. Why must a hierarchy of sympathy exist? Why can't we recognize that they are each victims, recognize their suffering individually, and have empathy for each of them? Why must there be a hierarchy? That seems unduly callous and punitive. If she was psychotic, she is a victim, full stop.

With all due respect--I just can't go there.

There are those who think all killers are psychotic to some degree. But, that doesn't reverse the victim/perp roles.

For me, and this is just MOO, the only victims here are the children and their surviving father.

There may be extenuating circumstances that will reduce the charges against her, but I can never think of her as a victim in the same way I think of her children as her victims.

Just all MOO.

 

[spicyrock]

So, I have talked a lot in this thread (it’s no secret that bipolar people tend to be able to talk quite a bit more than the average human, haha) and I worry a little that that takes up too much space for what mental illness looks like. Bipolar is just one disorder, and I am just one patient. LC was being treated for depression and anxiety as far as I can tell. I personally don’t see a similarity between the presentation of my psychosis and the presentation of hers, if she was psychotic. So I’m going to sit back for a while but I’ll still be here. <3

 

[nightowl1975]

Yes, that was my recollection from the arraignment, namely that her negative PPD diagnosis and checking into the hospital were in fairly rapid succession. MOO

I find it intriguing that they’re saying she supposedly didn’t have PPD, yet she was on 3 different anti-depressants over the course of a few months (Zoloft, Prozac, Elavil). I understand that a lot (most?) of the SSRI’s can also be used to treat other conditions, so perhaps they were trying to treat anxiety and throwing darts at the dart board so to speak, just trying to see which med “stuck”?

 

[BeginnerSleuther]

I'm asking for your description of what palliative care would look like for a psych patient deemed "terminal," to use the specific language of your previously proposed scenario. In your words and in your opinion, what would palliative care look like for a psych patient with a "terminal
prognosis?

Did you read the links? My description of what palliative care would look like is what's in the links I posted. I'm not sure what you're asking.

 

[BeginnerSleuther]

Whoa, I hadn’t made that connection about the first time she said it. Good point.

I can also recognize psychosis- at the beginning and the end, when meds are bringing me back. But I’ve experienced it many times by this point. The first time it happened it took weeks for me to really grasp what had happened. It sort of gradually came into my understanding- at first I thought I had been granted magical powers from the universe. Then I thought I had achieved a higher meditative state. Then I came to the more logical conclusion that someone had drugged me. Then finally I started to see, I had somehow lost my mind. Then I accepted that maybe I did have psychosis and finally, that this was bipolar. But now when it begins I can say to myself: this may be real or it may be psychosis. The only way to know is to take antipsychotic meds, check again in 48 hours. If it goes away, it was psychosis.

ETA, in my personal experience about the advice doctors give, I was advised to strongly consider not having a second child at all, because of the risk to me of having dangerous episodes and instability from discontinuing meds during pregnancy. I took that advice because I was concerned about a future where I couldn’t take care of another child. I don’t really mind having bipolar, it could be worse. But that’s the one thing I feel the illness took from me that was an unfair price to pay.

ETA: PPD/PPP we’re never explicitly mentioned. The concern was over bipolar episodes. But hormonal changes were mentioned.

I never advise my patients to come off med during pregnancy. Anyone with bipolar disorder, who is of child-bearing age, is put on meds that account for the possibility of pregnancy. We also engage in this conversation BEFORE pregnancy (which is why I make a point of saying family planning is part of their healthcare). All meds have risks, but some worse than others to the baby and those are the meds I don't use during pregnancy. If I know ahead of time she's trying to get pregnant, we may consider tapering the meds only for the first trimester.

You've now made me wonder if LC came off her meds during pregnancy. That would be horrible.

 

[BeginnerSleuther]

One thing I don’t think we’ve touched on is drug induced psychosis. I mainly associate this with methamphetamine, but I’ve read about other drugs causing it. Benzodiazepine withdrawal is rough. Could that have caused psychosis or psychotic symptoms?

Not a true psychosis. Benzo withdrawal can cause delirium and you can have psychotic symptoms when you're delirious. Antipsychotics don't actually stop the psychosis in that case. If a patient is hospitalized (should be on the medical floor because of high seizure risk with benzo withdrawal), we give antipsychotics to calm the agitation, but studies show these tend to improve when the delirium improves. In LC's case, I've never heard of a delirium-induced triple murder though.

 

[BeginnerSleuther]

I find it a little nerve-wracking that this is the first time I’m hearing of this, because I am bipolar and I don’t remember once throughout my two pregnancies my doctor even mentioning postpartum psychosis or being questioned during any follow ups after that. It’s especially concerning because I didn’t see just a regular OB, I saw exclusively an MFM, who one would assume would have a great amount of knowledge of everything that could go wrong during a pregnancy.

And just fyi, I totally believe you since I did my own research after you mentioned this, so I’m not questioning you. I’m just rattled a bit. If a MFM treating a woman with an established bipolar diagnosis doesn’t seem concerned about PPP, I can only imagine all the women who could fall through the cracks.

I'm really sorry no one told you that.

 

[BeginnerSleuther]

It's a strange one, it does seem to be used by some for treatment for drug resistant depression, although as of 2013 it seems there was little evidence for doing this.

Lamotrigine for Major Depressive Disorder Is Inappropriate

Lamotrigine is an important option in bipolar disorders. However, many clinicians also use it in patients with a (unipolar) depressive disorder who have not responded adequately to conventional antidepressants.

www.psychiatrictimes.com

The article you posted is about Major Depressive Disorder. MDD is not the same as bipolar depression. It's a different thing. Lamictal is used and works well for bipolar depression.

Re: the other meds she's on, again, until we know doses, we cannot make any assumptions. Yes, amitriptyline is an anti-depressant, but in all my years of med school, residency, and as a full-fledged attending, I've seen it used once for depression. It's almost always used in baby doses for sleep these days. Seroquel may also be used for sleep or anxiety (off-label). We don't know.

 

[infinit]

The article you posted is about Major Depressive Disorder. MDD is not the same as bipolar depression. It's a different thing. Lamictal is used and works well for bipolar depression.

Re: the other meds she's on, again, until we know doses, we cannot make any assumptions. Yes, amitriptyline is an anti-depressant, but in all my years of med school, residency, and as a full-fledged attending, I've seen it used once for depression. It's almost always used in baby doses for sleep these days. Seroquel may also be used for sleep or anxiety (off-label). We don't know.

Sure, I was under the assumption she wasn't diagnosed with bipolar which is why I wondered if it had been prescribed for depression.

 

[BeginnerSleuther]

Interesting article. The people I know with treatment-resistant depression have had every drug in the universe thrown at them, it seems to me. LC had a lot of antidepressant drugs thrown at her too (but only one SSRI- which again, makes me wonder about bipolar. But who knows, really. It’s just something I keep in the back of my mind, IANAD and we tend to see ourselves in other people). Maybe she had TRD.

I am still affected by the fact that she was trying to get help.

In fairness, we only know of one. She may have had others, either recently or even last year or the year before. There are people with 4 or 5 pages of med trials.

 

[BeginnerSleuther]

Sure, I was under the assumption she wasn't diagnosed with bipolar which is why I wondered if it had been prescribed for depression.

Ah, my mistake. Sorry, I thought you were saying it isn't used for any depression.