Lindsay Clancy & the 13 Medications Prescribed to Her: 48 Hours of No Sleep After New Med

Better being better boot. If you ever find the urge to occupy yourself entirely with learning about the directionality of strollers and the stroller wheels, is it an all-wheel baby stroller? There is dense literature to be read on Reddit forums about parenting and baby strollers. You will come out more educated on strollers and stroller wheels, but also equally confused on which exact stroller you should get for your new baby, but that is the surface level content on these parenting forums. It does in fact get much deeper because you could always stumble upon a post asking, "Is it normal to hear cries that aren't really there in the middle of the night?" Like phantom cries. They used to call it insanity of lactation. Post-predom psychosis is not like a modern day language, it's not a modern day thing. Back in the day, they said it was insanity of lactation. Post-predom psychosis, however, I will say, is not the same thing as post-predom depression. Post-predom depression is quite common, one in eight people who give birth experience it. Well, post-predom psychosis, it's pretty rare about one to two people per one thousand births. And that's kind of a distinction that's been lost in this case, where maybe, hopefully, very well-intended commentators out there of other mothers or other parents who are saying things like why I had post-predom depression really bad and I would never harm my children. I don't know if it's necessarily helpful or productive or perhaps even accurate input at this point. Post-predom depression and post-predom psychosis are completely different beasts, just very different. If you take the word post-partum out of it, it's like someone with depression saying that they never heard a voice that wasn't ever there. It's like, "Okay, well, that makes sense." And one would also imagine, because there's so different, that no one could ever mistake post-predom psychosis as post-predom depression, but that's not the case. Because people with post-partum psychosis also do have symptoms of post-predom depression. And from the outside, it could look like they just have post-partum depression, but the psychotic part is usually intermittent and hidden. Hidden meaning, it only presents itself for perhaps a small window. Patients can have prolonged, lucid periods where they're not really in a state of psychosis. And two, I mean, what are the odds that that times up when you see a provider, when you're talking to your therapist or your psychiatrist? There's also no standardized tool to capture post-partum psychosis. There's standardized tools to capture post-partum anxiety and depression, but not psychosis. One person on Reddit, years ago writes, "I spent a lot of time scouring the internet for PPP post-partum psychosis stories that match my own. I don't fall into the category of the most typical presentation of it. So a lot of times people will hallucinate that there's a lot of like religious hallucinations that the devil is coming for their baby. One mom wrote, "They believed that their husband was the second coming of Christ. And the only way for that prophecy to be fulfilled was if their child died. But it would be okay because the husband would bring the child back." And then they were saying like a lot of the things that they were seeing online just kind of fed into this like second coming narrative. Now some of these people are not even that religious before they entered into post-partum psychosis, but she says, "I didn't hallucinate that the devil was coming for my baby. I didn't even hallucinate that my husband wanted to kidnap him," which is another common thing. Like someone wants to kidnap your baby and you're the only one that can protect them. She says, "It was more subtle, like something growing in my lungs. I knew I couldn't breathe as easily, but I adapted as I went because I couldn't quite identify what was wrong. I lost myself. I fell into a deep depression." She says, "Once that depression hit, the intrusive, like weird thoughts started coming." She says, "It started off just as thoughts, intrusive, scary thoughts. So this is where it gets even more confusing when she says that she falls into a deep depression. When she sees a psychiatrist, that could present itself clinically as just post-partum depression. Then she starts having intrusive thoughts. There's also something called post-partum OCD, where it is someone who just gave birth, and a lot of these people, they have a hard time even coming to providers for it because they're scared their baby is going to be taken away. There is one woman who says that she had to, every time she went up and down the stairs, she had to sit on her butt and scoot from one step at a time because she had this intrusive visual that she would chuck her baby down the stairs. She didn't want to chuck her baby down the stairs, but she's almost like, "Why do I keep thinking this thought, unless I secretly must want it?" Which is actually a huge thing with people who have regular OCD, not post-partum OCD. They think their intrusive thoughts are some sort of reflection of their deepest wants and desires, but that was her post-partum version of it. So she's like, "If I don't want to actually chuck my baby down the stairs, why do I keep thinking about chucking my baby down the stairs?" There's also a lot of people with post-partum OCD that are too scared to report this to their providers, but they say that they couldn't even change their kid's diapers because they kept having an intrusive thought of essaying their own child. And they would never, but that is literally what OCD is. I know a lot of people that online think OCD is like, "I got to tap my foot five times. I got to make sure the stove is off six times," but a lot of OCD are just like really intrusive thoughts that are like, compulsion, you can't stop it. So then she's having these intrusive thoughts. So like this is, it's just, the clinical presentation is very confusing. So she goes from feeling depressed to all these intrusive thoughts, and she thought it was nothing more than that, but then they started growing. So she moves out of the intrusive thoughts. She says, "While playing peekaboo, I would leave the blanket over his face just a little longer than necessary. I would think more and more about how if I couldn't even take care of him, no one else could either. I dangerously kept quiet about all these thoughts. I previously had passive thoughts wishing I would get hit by a car and require hospitalization just so I could escape. I needed to escape this never-ending cycle of sleep deprivation, crying from me and the baby and isolation, but those thoughts eventually turned into plans of how I could self-exit. I weighed my options. I mean, I clearly wasn't right. I couldn't put it into any other words. I felt wrong. I felt broken, but I didn't know how to articulate it or ask for help. If I was honest, I was really scared that someone would take my baby away from me. But then things got worse and they got worse really fast. She does ask for help. She gets put on so loft, and it doesn't matter. Because a month later, she's taken to a psychiatric hospital for a week after a self-exit attempt. And from reading one too many forums about post-partum psychosis, a lot of people who have experienced it say, they presented primarily with symptoms of depression and anxiety. And the people around them saw symptoms of depression and anxiety. Now, that's not to say that having post-partum psychosis makes one harm their child. Nor does it mean that Lindsey Clancy herself had post-partum psychosis. All this means is there's a big debate. And this debate is not black and white, and this debate is not, oh, take her blood, see if she has something in her system. It's a huge debate of did she or did she not have post-partum psychosis, and that question is going to be life in prison or not, and it's going to play a very big role in her trial, and her potential new upcoming trial, if there is one. This is the case of Lindsey Clancy. We would like to thank today's sponsors who have made it possible for Rotten Mangle to support post-partum support international. Their mission is dedicated to promoting awareness, prevention, and treatment of mental health issues related to child bearing in every country worldwide. This episode's partnerships have also made it possible to support Rotten Mangle's team of dedicated researchers, and we'd also like to thank you guys for your continued support. As always, full show notes are available at RottenManglePodcast.com. This case has a lot of heavy themes of mental health conditions like post-partum depression, psychosis, bipolar disorder. However, the details of this case are not representative of these particular diagnoses, and no generalization should be made from this case about those conditions. There are mentions of taking one's life as well as the lives of others, particularly children and infants. We may mention various opinions, speculations, comments, all from the public about this case, and those involved. These are not representative of our own or are they legally confirmed. Everything available for this case that we pulled from is public information, so keep that in mind, and statements, quotes, "maybe some minds condensed or shortened for brevity." This is going to be a multi-part series. There's a lot of ground to cover, and before we even get into the whole Patrick Clancy and Rachel Danes' 60 Minutes interview, which is going to be in the next part, before we get into all of that, I feel like there is some necessary groundwork that needs to be laid for the legal aspect of this case, the post-partum psychosis debate, as well as all of the medications that Lindsay Clancy was on at the time, and all of the ways that her prescribers are either under fire or are being praised by people online, of whether or not they helped or failed Lindsay. There's just so much before we can even get into Patrick that we're all going to cover in this episode right now. So with that being said, watch with discretion, take care, and let's get into it. It's not impossible to be depressed. at a wedding but hopefully it's not your wedding that you're depressed at September 17th, 2022. This is four months before the Clancy children are killed. Their parents, Lindsay and Patrick Clancy are in New Hampshire. So they're from Massachusetts but they're in New Hampshire for a friend's wedding. Their family members are helping take care of the two older children, Kora and Dawson and they brought along the four-month-old newborn Kallen with them. So he's four months old and they're walking downtown in New Hampshire and Patrick recalls Lindsay telling him, "I think I'm going to start taking Zoloft." Zoloft is a very common SSRI. It's an anti-depressant and he says that Lindsay told him, "I think it's really going to help with anxiety and with going back to work." From the statements made by Patrick, it appears like this is the first time Lindsay ever brought up Zoloft or at least in this time frame since Kallen was born. To the point where he was even wondering, "We're going to get the Zoloft." What are you talking about, right? He didn't know that by this point when she's talking to him about Zoloft, she already had the prescription for Zoloft. She got it two days before. But the conversation stands. She hasn't started taking the Zoloft so technically she is informing him, "I think I'm going to start taking Zoloft." And she does. Lindsay Clancy starts taking Zoloft about four and a half months after giving birth to their third child, Kallen Clancy. Patrick says he doesn't know the exact time frame that she was on the Zoloft, but she just kept getting worse and worse. There is something called the GAD test. It's the generalized anxiety test. It's got a list of questions for patients to answer. It's pretty straightforward. Very easy questions. Do you feel anxious? Do you feel anxious a few times a week, several times a week, most days of the week? It's not a very thorough test. I mean, it's a screener. So do you feel restless? Questions like that. And then it spits out this random numerical score and it's just a screening tool. It's not a diagnostic tool. For feeling nervous, anxious on edge, Lindsay responds that she feels that nearly every single day. For not being able to stop or control the worrying, she feels that nearly every single day. One of Lindsay's providers later says, she was significantly high in the GAD 7, which is for generalized anxiety. She scored 21 out of 21, which I mean, they're just screening. So it's not diagnostic, but it did indicate that she was experiencing some extreme anxiety. Now, I was on Reddit and I was like pulling from even my own personal experiences of taking the GAD 7 test a few times. I've yet to see many people on even Reddit hitting the 2021 mark out of 21. Even at like the peak war, I've ever been in was like 17. And that seems to be on par with a lot of redditors. It's like a lot of people seem to hit 14, 13 from what I can tell. And then 17, 18 is like, okay, things are not great. But like I could not find many people who are hitting 21 out of 21. So hitting the ceiling of this GAD 7 test, I would imagine is incredibly concerning. So two days before Lindsay tells Patrick at the wedding that she wants to get on so loft, she is meeting with a psychiatrist, Dr. Jennifer Tufts. So I'm just going to give you a quick timeline. September 12th, 2022, Lindsay finds Dr. Tufts online and schedules an appointment. This is really important. So Lindsay looks up doctors and she finds Dr. Tufts. I'm assuming that she goes on her website, sees, you know, everything that she's advertising on her page of the things that she specializes in and then books an appointment with Dr. Tufts online appointment, right? Yeah, it's a telehealth appointment. September 15th, Lindsay has her first telehealth appointment with Tufts. And then September 17th, Lindsay tells Patrick, she might want to start so loft. Now she's already prescribed it September 15th two days before. But back to this very first meeting, Lindsay reports to Dr. Tufts that she feels okay. I mean, okay, right? Dr. Tufts takes notes that Lindsay appeared a little bit anxious, which makes sense considering that seems to be Lindsay's biggest concern for this appointment is she just seems to have a lot of anxiety. She just gave birth to their third child in May of 2022. It's now September. So only about like four months, Lindsay's not feeling well. This is peak postpartum period. A lot of people say it's about a year. Some people will go as far to say it last two years is the postpartum period where you got to look out for postpartum depression psychosis. But Dr. Tufts prescribes zooloft. And Lindsay is really hesitant about this because she remembers that she was prescribed zooloft when she gave birth to her second child, Dawson. And she just had concerns about breastfeeding while taking the zooloft. I will say that zooloft is probably one of the safest medications to breastfeed on. But I think everybody has different standards for safety when it comes to their own children. And that seems to be what applies here. She seems very hesitant, but yet still kind of open to the idea. She even brought it up to Patrick. And eventually two weeks later, she starts taking the zooloft. So she doesn't take it in September. She gets prescribed it September 15th. She doesn't take it until like mid-October. So actually more than two weeks. A month. Yeah. The original dose was 25 milligrams. And then it gets increased to 50 milligrams because it's how it works. You ramp up. And this is not an abnormal dosage for zooloft. This is nothing concerning in terms of the dose. And once Lindsay hits that 50 milligrams dose, Lindsay hates it. She reports that she has such severe insomnia. She was awake for 48 hours. She had racing thoughts worsening anxiety, which is like the whole point that she's going on zooloft. This is just miserable. So she tells this to Dr. Tufts. And they stop the zooloft. I discussed with her and her husband the possibility of potentially an underlying bipolar disorder. I based this on several factors. One of them being that she had such what we call an activating response to the zooloft. It's unusual for somebody to describe taking zooloft and then going 48 hours without sleeping not being tired. There's a huge very probably meaningful conversation about Lindsay's reaction to zooloft. A big bold preface here is zooloft is the brand name. The drug is satcheline. Satcheline does not create bipolar disorder. Okay. But there is an argument that if you take zooloft or similar SSRIs, it can push someone who already has an underlying bipolar disorder out of depression and straight past what they describe as normal and into a state of hypomania. Some psychiatrists call it the anti-depressant induced mania. And there are lots of anecdotal stories of people saying like, hey, I didn't even know that I was bipolar until I was prescribed zooloft because I went into my psychiatrist and I was showing symptoms of being depressed. So they thought that I had major depression. Then I took zooloft, then I took all these other SSRIs, and I went into a state of mania, and that's when they're like, oh, so actually your diagnosis is not major depression. Your diagnosis is bipolar disorder, typically bipolar disorder too. Right. The FDA has straight up stated. In patients with bipolar disorder, treating a depressive episode with zooloft or any other anti-depressant may precipitate a mixed manic episode. The FDA instructs prescribers to quote screen patients for any person or family history of bipolar disorder, mania or hypomania, which hypomania is similar to mania. But instead of the duration being like seven days and needing to be hospitalized, it's at least four consecutive days of very hyperactivity. And hypomania, the scary thing for a lot of people is that from the outside, it could appear that you're functioning completely normally when you are in a state of mania. So from the outside perspective, you actually seem like you are functioning better than most people. You might even be more productive. You get four hours of sleep, you're talking fast, you start three new projects, you're running on some sort of high-end life. You have this very sure feeling that you can take on everything, but also your attention span is kind of shot, so you're switching between tasks non-stop, but somehow you feel upbeat. You get high energy levels, even if you're not sleeping as much. But what happened after that period? Usually it is a very depressed state. Right, okay. And it's very dangerous because there is really, it doesn't appear that there's a strong guideline for how long these manic states last. And there's different types of mania. And different types of mania can be scary for one. It's hard for a lot of providers to identify that you're manic when you're in certain states of mania. And then two, it creates like the perfect tornado to usually that could lead to self-exit. One person says the same thing happened to them when they took Zoloft. They said it triggered a hypomanic episode at the time, and I just thought, "Wow, these antidepressants work really well for me." And then my psychiatrist switched my misagnosis from major depression to bipolar two. There's this one post on the OCD subreddit that reads, "I just took Zoloft last night. What the fuck is going on?" I'm looking with 3am and I'm wired. Like, I feel incredible. Everyone talks about how SSRI's take forever to kick in. I feel so fucking good. I could probably do anything right now. Like I feel I'm kind of jittery and I have so much going on right now. To which all the comments are all warning the OP to tell their psychiatrist, because it sounds like they're having SSRI activating mania. Making things even trickier is that it appears a lot of people will prescribe zoloft for those struggling with depression. But unipolar depression. So unipolar means someone that does not have an underlying bipolar disorder diagnosis. That means they just have major depression disorder, right? They will react to the zoloft vastly differently from someone who has an underlying bipolar disorder. But the front facing symptoms, like the clinical assessment of both those people, they all indicate depression. They look the same. And to make things even more complicated, the postpartum period has the highest risk window for those with bipolar conditions. Many women report having their very first bipolar episode after child birth. And while postpartum psychosis is really, really rare, it's less rare for people with bipolar disorder versus those without. So one statistic says the risk of postpartum psychosis for those with bipolar disorder is no longer like one in two out of a thousand births, but it's closer to 17 to 50%. And again, just because someone has postpartum psychosis does not mean that they are danger to their children or themselves. They definitely probably need medical intervention, but that does not mean that they're going to commit acts of violence. That's not what I'm saying, but they are just higher risk. And now I will say the people with bipolar disorder one are usually at much higher risk than people with bipolar disorder two. Bipolar disorder one just to really simplify it is a more severe version of bipolar disorder two. And just to reiterate, the conversation is that certain SSRIs can accelerate a diagnosis for bipolar disorder. That does not mean it causes it. That person typically has the underlying condition that was never diagnosed before. Also, there are a lot of people who have bipolar disorder and do really well on SSRIs. I believe they are not the only medication that they take typically, but they do well on SSRIs. And they should go without saying, but just in case having bipolar disorder does not make one violent or more likely to harm others, like most conditions of the mind, I believe it is the most damaging to the individual with them, rather than those around them or society at large, which it is 2026. We get it. But like, just in case I have to throw that in there, the reason that we're going so in depth on a potential bipolar disorder two diagnosis for Lindsay is because that's a huge part of the debate just during trial, during everything. So at first glance, it seems like this case is about postpartum psychosis. And that's the only debate. Did she have it or not? But the underlying debate for that is whether or not she was showing signs of bipolar disorder, whether or not her providers did not pick up on it and did not treat it, which ultimately pushed her into a state of postpartum psychosis. Bipolar disorder does become a very big topic of conversation. And again, just because it is being debated that Lindsay's usage of Xoloft could have activated a manic response does not mean SSRIs have this impact on anyone that's bipolar or not bipolar. And also SSRIs are known to have saved millions of people. So this is not some sort of fear mongering of SSRIs. And just because it's being debated that Lindsay could or could not be bipolar, it does not mean that her being bipolar is what caused the incident. Nor does it mean that anyone with bipolar disorder becomes more dangerous to family members or children. Or does it mean that she should be found guilty or not guilty or not guilty by reason of insanity? I'm just giving you a lot of context. In October, October 24th, 2022, to be exact, Lindsay writes in her iPhone notes, affirmations, "I am strong, I am brave, I will get through this, I will overcome postpartum anxiety and depression, I'm a great mom, I love my kids, I love my family, I love my life, I am happy, I take care of myself." Then she has a section titled Gratitude. "My mom for being there for me no matter what and coming to help at the drop of a hat, my husband for picking up the slack when I've been feeling so down, my husband for taking the big kids out to do things when I felt like I can't. The knowledge of how I can turn things around naturally, the space in my house to do this routine. So this is around the time that she starts taking the zoo loft. Start? Oh, mid October, I see it. Yeah, so around the time of zoo loft, Dr. Tufts does give her reasoning for why zoo loft? Because that's a huge again topic of the conversation. And she says, "So it's a first-line medication used for treating anxiety disorders. It's also a first-line treatment when women are breastfeeding, it is the safest SSRI for babies." Tufts says that her initial diagnosis of Lindsay is generalizing anxiety disorder and it was an adjustment disorder with depressed mood. Dr. Tufts prescribes the zoo loft. Like I said, first at 25, then ups it to 50. Lindsay posts on a postpartum Facebook page. It's called, "I am not alone postpartum depression anxiety and rage Facebook group." And she writes, "Looking for advice, no medications for PPA/PPD. Postpartum anxiety, postpartum depression. I tried zoo loft and after taking it for a week and increasing it to 50 milligrams, I had extreme insomnia and also felt like it was worsening my depression and I had no appetite whatsoever. So I had to stop taking it. Has anyone had a similar experience and found a different medication that worked?" Lindsay also reports list to Dr. Tufts that she took the zoo loft, increased her dosage and she couldn't go to sleep. Tufts testified that Lindsay told her that she felt awful. "She did have some stomachaches. She had some diarrhea and had a difficult time eating. She also had increased anxiety. She had some more depressed feelings. She had more difficulty sleeping." Tufts notes at the time read that she felt awful. She couldn't sleep. Had insomnia, which became worse when she increased the dose. She didn't want to eat. She was having diarrhea. Food felt really unappealing. She was more depressed on it, crying all day yesterday, which is not normal for her. She had some mental fog and was terrified to start something new. Anxiety was really bad even before med. Now hard to differentiate, overnight racing thoughts, paranoid of getting suicidal thoughts, something bad happening doesn't want to be alone. Tufts immediately tells her stop taking the zoo loft. Now, zoo loft and SSRIs are typically a medication that you cannot stop cold turkey. You have to taper down, but Tufts does explain this dosage was relatively low, so there was no need to taper down off of it and a lot of physicians and a lot of psychiatrists agree online. So stop the zoo loft and they meet again through telehealth six days later, October 26th. And at that meeting, Dr. Tufts says Lindsay was feeling back to how she was before the zoo loft, which is not great still, and that she was considering a new medication. Around that time, Lindsay writes in her iPhone notes, "I'm sad and depressed because I'm not able to parent my third child like my first. I want to treat to any one of my babies like my first, but I know that's not a feasible possibility. I'm sad that I stop breastfeeding. I feel not as connected with Cal now. I think I sort of was at my other children because they prevent me from treating Cal like my first baby. I know that's not fair to them. I know that. I was feeling so depressed last evening when Corrin Dawson came home from school. I know it rubs off on them, so we had a pretty rough evening. I want to feel love and connection with all my kids. I'm also probably having a bit of internal conflict because my whole life, I wanted to have a lot of kids. I still don't want Cal to be our last, but I have a lot of figuring out what to do before I have another. I'm on the fence about starting a new medication for anxiety and depression. I just want to feel happy. I just want to be able to relax and take care of my kids, and when they go to bed at night, I want to deeply relax and hang out with Pat and then fall asleep into a deep sleep for eight hours. Get up and pour hard into myself for an hour and a half. Cal was so very planned and desired. I want to be able to give him all the love he deserves. I guess that's what it's like to be the third child though. He's not the first third child to exist. I think I know he'll be okay, but it's really hard for me. I hate that he has to put himself to sleep. I'm sad. I'm not breastfeeding anymore, but I think deep down these are the right choices. She writes that she simply doesn't have the opportunity to catch up on sleep. She doesn't even have the chance to take a nap during the day. She says, "When Cal naps, I have to take care of Koran Dawson." That's just how it goes. I guess I should also feel slightly traumatized by the sleep training, but that feeling was only really present when I was severely sleep deprived and paranoid. I know what we did was the right thing, and okay. She writes, "I still really want a fourth child, but I need a really good therapist before then. I'm on the fence about starting a new med or not. I want to feel happy, but it would be nice to feel authentically happy and not fake, but I need to feel happier than I did last evening because then I was pretty depressed and not enjoying any of my children. It was really sad. I'm struggling so hard because I wanted to parent each of my children like my first, and since I can't, that's depressing to me. This is definitely the root cause of all our problems. Now I feel like I'm not parenting any of my kids the way I want to, and that makes me sad. But I'm going to try my best today. I've just fallen out of the habit of doing anything for fun, anything for myself, anything for Patrick, and I need to work on that. On a positive note, I had a great deep night of sleep. I'm terrified of something happening to my kids or doing something wrong to. mess up their development. Our generation is inundated with information about every aspect of parenting and everything that can go wrong if you just don't get it right. And all the scary things happening in the world, it's insane. For the past five years, I've just filled my mind with all these parenting and it's just unhealthy. This note has been interpreted all sorts of ways online. Some say this note is proved that she knew exactly what she was doing. They think that her journals and her future entries included which we will cover so that Lindsay was not hearing any voices. Otherwise her writing would have been a little bit more disorganized. There would have been some hint at a voice. There would have been more paranoia seeping through these notes. These sound like an exhausted mom who has no way out. Others argue that it shows that she's clearly struggling and trying to get better, that she's screaming for help. She's not getting much help. And a lot of others say this actually could indicate Mania. Interesting. So there are a lot of people who have come forward and said that when they were in manic episodes, they write like crazy. They talk and they write extensively. And you know, there's a lot of debate online of people. I think the only way really that anyone would be able to know is if Lindsay was some sort of avid journal or prior to all of this, that would maybe clear the air a little bit other than that. We're just speculating at this point. But a lot of people have come forward to say, at this point in time, Lindsay is not seeing a therapist. She's seeing a psychiatrist. And nowhere in Dr. Tufts testimony did she say, Hey, I told Lindsay to write down her thoughts when she has thoughts. And a lot of people say that it is not a natural thing for many people suffering from depression to take a lot of notes unless instructed by a provider. Because the act of taking notes, I mean, with people struggling from major depression, typically they can't even get out of bed, even basic hygiene is difficult. And so to formulate these longer thoughts and write it all down, it does not seem like it's depression and could maybe be more so Mania. And then also other people are indicating this feels like when people are in states of Mania, there's something called pressured speech and we're going to get into it. But it's when someone has so many thoughts and they want to detail all of their rapidly racing thoughts that they just keep talking. And then you can interrupt them. This feels like pressured writing basically. But again, that is just speculative. We don't know. So there weren't a bunch of notes from her app, notes app, like messages she wrote written, there's not like a ton of them. Well, there were, but in all in this period. So I don't know if like when Lindsay was pregnant with Callan or before, did she? Yeah, we don't have that information from the police. We don't know if she's just someone who journals like this on a weekly basis, because that could change things. Now, if she's someone that has never journaled in her life, and suddenly she's like writing long monologues in a state where people are saying, you look depressed or you know, she's giving off symptoms of major depression, it just a lot of people think it's kind of strange. I see. And another thing to note is some people say that there is this confusion with being in a manic state and it being associated with being euphoric or someone being overly energized and hyper and just talkative and non-stop go, go, go. But there are states called mixed mania where you rapidly cycle through periods of energy and irritability and then it swings really quickly to depression and it just swings back and forth so rapidly. It is actually considered one of the most dangerous kinds of mania because of the elevated risk of self-exit. Nevertheless, Dr. Tufts then prescribes Lindsay 0.5 milligrams of adivan, which is basically lerasapam and she prescribes at prn, which means take as needed, so not a daily medication. Adivan is a benzodiazepine, which means it's going to instantly help with anxiety, but it doesn't do anything to fix the underlying issue of anxiety, plus it's highly addictive so it's not for long-term use. Another example of a very common benzodiazepine that I think more people would be familiar with, just due to culture of movies and TV Xanax, right? It's a controlled substance and by October 26, Lindsay tries the adivan and reports that it did help with the anxiety, but it still didn't help her go to sleep. She tells Tufts that she tried taking over the counter-benadryl to help with the sleep since the adivan only helped with the anxiety and not the sleep, so that is when Tufts prescribes hydroxazine at 25 milligrams. Hydroxazine is an anti-histamine prescription and it's offered as an alternative anxiety option. So this is another prn prescription, so take as needed, so instead of taking the benadryl, take the hydroxazine, that's the idea here, and then take the adivan when the anxiety is unsurmountable, like when you really need to take the adivan, but do not take the hydroxazine and the benadryl together. Then Tufts decides that she's going to prescribe a boost bar at 5 milligrams twice daily, so boost bar is an anti-anxiety medication that you do have to take every day, and typically you feel the therapeutic effects within like a week or two, so we've dropped the zoeloft, we've added in boost bar, which is the daily anti-anxiety medication, then you have the anti-histamine, basically the prescription benadryl, take as needed, and then you have the benzodiazepine take as needed for severe anxiety. Lindsay is very hesitant to start the boost bar, according to Dr. Tufts, she's just overall very hesitant to start new medication, so while she has the boost bar prescription, it's unclear if she started taking it at this point, and Lindsay starts talking to Dr. Tufts about perhaps tapering down from the adivan. This is November of 2022, so we're like two months in, right? Adivan is a very short term prescription, there is a huge dependence risk there, so they decide to start a slow taper, because you can't even just cut benzodiazepines, because benzodiazepine withdrawal can be very, very serious, some have described it as being plunged into the depths of literal hell, you can actually die from the withdrawal, and that's not like a figurative, like oh my gosh, you could actually die from the withdrawal. I don't think that would be the case for Lindsay in this particular dosage at this length, it goes to say it's very dangerous. And around this time, on a postpartum forum, November 8, 2022, Lindsay writes in part about Zoloft and Adivan. She writes, "Also right now, I feel the only medication that works for me is Adivan, it has the perfect effect of decreasing my anxiety and making me feel happy, it makes me feel like myself again, but I know that it's not a long term solution as it is addictive, any advice on any alternative that has a similar effect, which there's not really many, there's a reason benzodiazepines are controlled substances and our first short term use. I actually knew someone who was heavily dependent on benzodiazepines, and like I don't know if there really is anything other than benzodiazepines that could be a replacement. It's kind of considered unmatched for immediate anxiety relief, and that is why it is quite dangerous, and you do get physically addicted to it rather quickly, then just for the sake of following the timeline. We also get another boost bar prescription in November, but Lindsay tells Dr. Tufts that she never started it because she was afraid of, you know, starting new medications, but that second boost bar prescription does show up. And this is where there is a lot of conversation, and it's going to feel very tricky to follow and just confusing, but there were 13 different medications that were prescribed to Lindsay from September 22 to January 2023. However, some of these prescriptions are replacements to other medications, and just because Lindsay was prescribed it does not mean that she took it, and it does not mean that she was taking all 13 at the same time. It's just very confusing. I will say even for boost bar, just like to give you an example, she has two bottles of boost bar, two boost bar prescriptions, right? For one of them out of 30 pills, all 30 pills are in there, but another one out of 30 pills, there's only 28 pills. So that means there's two boost bar pills unaccounted for. Did she take the two and then decided that she didn't want to take it anymore? If that's the case, it doesn't seem like she reported that to Dr. Tufts, or Dr. Tufts never testified it or had it in her notes, so we don't know. Also, boost bar was not found in Lindsay's system on January 24 during the toxicology reports. I will say that boost bar's half life is around two to three hours, and then usually within like a day, the boost bar would be out of the system, but did she take the two boost bar pills that are missing? When did she take them? Why did she stop? Why did Dr. Tufts not know that she had maybe possibly taken their two boost bar pills? So all of this is just just because she's prescribed something, doesn't mean that she took it. It's just confusing. Now, it's not the most pertinent question in this case, but it just goes to show there's a lot of mental work that we have to make work of of what she's prescribed, what she ultimately takes, what actually impacts her, what she's prescribed, but doesn't take what she tells the prescribers, and then ultimately what's found in her system January 24. It's confusing. Dr. Tufts' testimony has sparked a lot of conversation online with people either hating her or thinking Reddington was trying to make her a scapegoat. She is also named as a defendant in two civil suits, one by Lindsay Clancy for personal injury, and basically malpractice, and a wrongful death civil suit brought on by Patrick Clancy. So they are separately suing a lot of the providers. And people have a lot of opinions about Patrick Clancy also suing the providers. So there's a lot of mixed feelings. Some people think that Patrick shouldn't be suing, some people think that Lindsay shouldn't be suing, and it's just that is another fight in itself. For Lindsay's civil suit, it states that essentially after prescribing Zoloft, and after hearing Lindsay's reaction to Zoloft, Dr. Tufts did not recognize the significant role of the reaction. They're saying, like, any good provider would realize, like, this is not normal. This is a clear indication that she is probably has bipolar diagnosis that's underlying, and this activated some sort of manic response. Is this being discussed in the court room? Yes. Yeah. I would say that it's not a big part of obviously the Commonwealth's case in chief, but the defense brings in a lot of experts, and there is a lot of heavy discussion on bipolar disorder, and then the prosecutors bring in rebuttal experts, it's a whole back and forth. It's not even just a debate of, did she have postpartum psychosis? It's also a debate of, does she have bipolar disorder too? I see. And should these providers have known it? But the civil suit says that Lindsay had such a strong adverse response to a relatively low dose of Zoloft, they should have known. For Patrick's lawsuit, it reads in part, Dr. Tufts prescribed Lindsay a variety of different medications, but failed to monitor her reactions to these medications, or attend to her worsening psychiatric condition. I will say, Lindsay's time as a patient with Dr. Tufts does not end with a new boost bar prescription, but there are other providers that get involved later, so just to keep it on Tufts right now, during her direct testimony, Tufts states that she's been a psychiatrist for close to four years now. Lindsay comes in to see her, and she indicates in her intake form that she feels decreased appetite, depressed mood, anxiety attacks, easily distracted, excessive worry, guilt, unable to feel pressure, unable to fall asleep, racing thoughts. She reports that she feels down, depressed, and hopeless more than half the days, and Dr. Tufts says, "It is part of her job to look for signs of psychosis in patients." So when she's asked about those signs, she says, "It might be that they appear disheveled. I assess what their attitude is, if they might be agitated or very uncooperative, that's a red flag. I will assess what their speech is like, is it very loud, is it very fast, or sometimes it could be the opposite where they're not really even speaking at all. I assess what their mood is like, what they're saying that they're feeling, and how they appear visually." She says that she looks for disorganized thoughts, and that's typically through like the content of the conversation. If anything sounds very bizarre or very paranoid, that would potentially be indicative of psychosis, and she says she does that by asking questions like, "Have you ever heard voices? Have you ever seen something that other people didn't see?" Which some people are like, "These are pretty bad questions, but I mean, I think it's probably protocol," right, "Tuffs believes that she asked Lindsay, and Lindsay's response was no." During the cross-examination, defense attorney Reddington first questions "Tuffs' experience as a psychiatrist," because when she sees Lindsay, Dr. Tuffs had completed her residency and had been practicing as a psychiatrist for a little more than a month. I do see a lot of people harping on this issue. I have been downed a lot to forums of people that are in health care. That's a whole point of residency is you get the experience through residency, so a lot of people think that this is incredibly unfair for this to be the focal point. However, there are other things to take issue with. This just might not be one of them, but people have taken issue with it. Reddington asks, "Dr. Tuffs, I'm asking you, when you started working in August of 2022, how many patients had you treated before you saw Lindsay Clancy for postpartum psychosis?" So he's saying like, "How many other?" And she says, "Well, in the span of one month, I would say none because it's a very rare disorder." How about postpartum depression? How many people in that month or so before you met Lindsay, did you treat for postpartum depression? In the span of one month, it's really hard to pinpoint that, maybe a couple. The clinic that Dr. Tuffs is working for had her on the website as, "Okay, well, this is what Reddington says." Well, one of the things you did is that you said that you were basically a specialist in the postpartum. You indicated that on the website, didn't you? Tuffs says, "It's listed as one of her interests." Lots of you have problems with this. Okay, netizens are like, "Yeah, okay, next time I'm just going to list shit on my resume and say it's an interest of mine." Reddington says, "And again, forgive me, how many women did you treat for postpartum depression in that month and a half before you met Lindsay?" I don't know. Maybe a couple, but I've treated many of them in residency, which was just immediately before. Some believe that Reddington is too antagonistic, asking about Tuffs' residency, and I think a lot of people can agree that maybe the clinic that she was working for probably should not have listed her for something that is as complicated, even if it says the word "interest on there," like an interest of Dr. Tuffs' women's health care and postpartum. People think that it's incredibly reckless for the clinic to list her who has just been working independently as an attending for like a month and a half, when this is such a sensitive, even for people with years and decades of experience very difficult to identify. They think that was reckless. However, they think that Reddington, on that same note, is also reckless in his line of questioning, but you do have to remember, the jurors are probably not healthcare professionals. I mean, there was a nurse on the jury, but you're talking about a lot of people who are not healthcare professionals. So while this cross-examination, when I was on healthcare forums, they were saying eat was the worst thing that they've ever heard in their lives, and they were getting pissed off at Reddington. But a lot of people are reminding them, "Reddington is not doing this for you, or for healthcare. Reddington is doing it for the jurors." He's speaking whatever angle is going to work on a normal person, yeah. And this is the angle where he's asking about her doing residency during the pandemic. Did you touch people, shake their hand, give them a hug or anything like that while you were working in your residency during the pandemic? Sometimes I think everybody had to keep their distance at certain times. I began my program before the pandemic, so of course there was a lot more handshaking and things like that than Reddington asked toughs. You're defended in a very large lawsuit. Are you not objection overruled? Yes. And you know that the outcome of this case is very major to the outcome of your lawsuit. Objection overruled. I don't actually know that. So you understand that if in fact it's determined that you advertised as an expert in postpartum and in postpartum psychiatry and you've had a month experience plus a residency, would you consider that to be negligent or misrepresentation? I do not believe that I have been negligent. With a month under your belt plus your residency, do you really want this jury to believe that you were an expert? I don't think that's exactly the wording that I used. I think I said it was an interest of mine. Are you an expert in postpartum? I may be. I don't know. I think it depends on what you define an expert as. Tell me what brought Lindsay Clancy to your office. Postpartum anxiety. Reddington points out that Dr. Tuffs does not administer the Edenberg test for Lindsay, which Tuffs says she did do a different test, the PHQ-9, which is kind of like an overall depression screening form, but Reddington argues that's like generalized anxiety disorder, generalized depression. It's got nothing to do with a woman suffering from postpartum depression, does it? I disagree. Well, do you agree that people perhaps that may know a little more than you determined that the Edenberg scale is the appropriate scale to administer to a pregnant or postpartum woman? Then sustained as to form. The form of the question is not okay. You're familiar with the Edenberg scale, right? I've heard of it. And can you explain to me how it's graded? No, I cannot. There are 30 questions in it. Are they not? I don't use the scale, so I don't know how many questions there are. This is not Dr. Tuffs' problem. If her clinic does not use the Edenberg scale, however, I think the point that Reddington is trying to make is even if you list postpartum as an interest, but you don't even know the Edenberg scale, which is one of the bigger, bigger, well-known screening tests for postpartum anxiety and depression, is it really an interest of yours, even if that's not the screening tool that you use at the clinic, should you not at least know it? Because what if a patient comes in and is like, "Hey, yeah, I took the Edenberg scale with my last provider and I was like this? Should you not have a good idea of it?" And it's not an overly complicated scale, either. It's not like some crazy terminology and then you got to draw blood. It's just like a screening tool like the GAD7. Tuffs pushes back later, saying that it's not really her choice, whether or not she gets to use the Edenberg scale or the PHQ9 scale, that's the factor, aster, the clinic. That's what they use and that's what she uses, because she works for them. Reddington also makes it a point to show the jurors that they had 14 appointments from September to January, 14 appointments between Dr. Thompson Lindsay and every single one of them was telehealth. Yes. "Every single one of them were by telemedicine, weren't they?" Yes. "Until you came in this courtroom Friday, you never saw this woman in person, did you?" Correct. "She was crying, she told you symptoms that she couldn't get out of bed, isn't that right?" "At one time she said it was difficult to get out of bed." "Oh, difficult to get out of bed." "Why was it difficult for Lindsay to get out of bed?" "Because she was very depressed." "And did you give her a hug?" "Oh no, you were on telemedicine, so you couldn't give her a hug, could you?" "Okay, this is where I did think it went a little skewed. I do think like based off of the interviews that we've seen of the jurors so far, I think I can understand the ploy that Reddington is trying to make for the jurors that are in front of him. There's so many times he doesn't call it Zoom, he doesn't call it computer, he says you saw her through the television and he himself being an older man. It does seem very old school but there might be many members of the jury that resonate with that. However, a lot of younger people online are like, I only do telehealth, so I don't know what he's talking about. So there is a generational gap here of what I can see why he's doing it. He's critiquing the talent. Yeah. No, is that the morally correct thing to do? That's up for debate. Is that the smartest thing for a defense attorney to do? Probably, so that's probably why he's doing it. Dr. Tufts argues, I mean, she doesn't argue but she responds. I could look at her but it was always a video appointment. I couldn't give her a hug but that's not actually something that psychiatrists typically do with patients. Reddington points out that the angle of the camera and the teledoc appointments, you can't see certain manifestations that patients may have and that would point to them being stressed or emotionally disturbed. He says like hand-ringing. She's like, yeah. Were you able to see the hand-ringing when you were on telemedicine? I don't recall seeing her hands. You recall how people sit there and they they do this with their leg and their leg bounces because they're going through some type of emotional stress. You couldn't even see her legs, could you? I couldn't see her legs but I knew that she was under stress. I think that I think Reddington is setting the scene. He's setting the scene because later on a different provider comes on and she states that ultimately she felt Lindsay's condition. She wanted to see Lindsay in person. And I think he knows that's coming and I think he's making an extra emphasis on Tufts testimony at this point to really hammer in throughout the times that you've seen her. You never once even considered telling her to come into the office. So this is again, he's trying to pinpoint no one was giving Lindsay the help that she needed. Dr. Tufts says whether an appointment is in person or through telehealth that's really up to not just Dr. Tufts but also the patient. She says if a patient ever wants to do an in person not through telehealth that is an option. Some parts of the cross examination that people are on the fence about I will say is Reddington asked Tufts about whether or not Tufts told Lindsay that self exit thoughts and actions are side effects of Zoloft. Tufts argues that that is mainly for children but Reddington says there's a black box warning on Zoloft and other SSRIs is there not. Tufts argues yes but it's mainly for children and adults that are younger than Lindsay. So the FDA determined that there is a self exit risk for children and anyone under the age of 24 years old. So Reddington is arguing Will Lindsay was 32 which is just like a few years older than 24 he says. He never even mentioned she's 32 he just keeps saying like a few years. So does that suddenly mean that she's no longer at risk taking Zoloft of having thoughts of self exit. Tufts argues back there's a lot of development that happens in the brain between ages of 24 and closer to 30. The brain is fully matured at past age of 24 so it's less vulnerable than in a younger individual. So with 24 years suggesting there's a cutoff are you suggesting to the jury that a drug that increases the risk of self exit in a 24 year old patient cannot increase the risk of self exit in a 29 or a 30 year old patient just a little bit. I don't believe there's evidence that it causes that at all in individuals over 24. Now I can see why people don't love this argument. There is a lot of demonization and fear mongering of SSRIs that is coming out of this case and SSRIs have been life saving incredibly helpful for millions of people everywhere like on a global scale SSRIs have there are horror stories of course like with any medication but there are people who would not be here without SSRIs. So they think that this type of language and that Reddington is using is only going to scare people from starting an SSRI when it's probably the best line of treatment for them. I guess maybe a more valid argument could be Reddington argues that another side effect of Zoloft could be quote severe trouble sleeping. Insomnia. Did you tell her that? Well, Insomnia is listed as a side effect. No, no, no, no. Did you tell her that Zoloft has a side effect of giving the patient severe trouble sleeping? That's all. So I didn't use the word severe because it typically doesn't cause severe trouble sleeping but I thought that you were referring to when she told me that she had severe trouble sleeping but she's basically saying like she didn't think that Zoloft and the problem of not falling asleep was a big problem for Lindsay. But Reddington is arguing why would you prescribe Zoloft to a young woman who is postpartum who's coming to you with anxiety? This is his direct quote. Who's telling you she can't sleep? She's got all these symptoms and then you prescribe a medication that would have had a side effect of trouble sleeping. So individuals have very varied responses to medications. Some have no side effects. Some have one or two. It's impossible to predict that. Zoloft is a top choice, a first-line medication for her. Says who? The general consensus among psychiatrists, there's extensive research supporting the use of satchelene in this instance and the general consensus among psychiatrists that it's a first-line safe medication for individuals including postpartum women. How about the kids that shoot other kids in high school and the lawsuits that come out against Zoloft? Okay, so again this is the part where I do think that Reddington is demonizing Zoloft for a specific medication. Just for the defense of his client. I think there's a lot of other ways to defend his client. I think again we're just heading into weird territory here with the SSRIs. That gets objected overruled but he continues to ask. So you didn't really talk to her about increased risk of self-exit with 24-year-olds because she's what four or five years older than that. You didn't talk to her about the trouble sleeping which could be a side effect. He asks her if there couldn't be any other drugs that she could have prescribed. That would have been perfectly safe and common and allows someone with no psychiatric history to sleep better. And she responds not necessarily. Reddington starts asking about Lindsay's reaction to Zoloft and again one of the things that Lindsay tells toughs is the mental fog. Racing thoughts doesn't want to be alone. It doesn't want to be alone. What does she mean by that? Will those swear a lot of her words? Right, isn't that a concern? If your patient is telling you she doesn't want to be alone, why didn't she want to be alone? So he's trying to hint at like usually people say that but as a mental health professional that typically means they might be scared of something or paranoid. You can't just take it as I don't want to be alone. And she says and I think you know there is a debate a lot of netizens also say you know when you are dealing with someone with pretty severe depression, they want to be alone. But she's saying she doesn't want to be alone after taking the Zoloft and she's having these racing thoughts. A lot of people think it's pointing towards Mania and paranoia. So it's just like she should be able to pick up on that is what people are saying. But tough says because she was very anxious and had the feeling like something bad might happen. But we never get a clear idea of like what that's something bad is. And later tough says it's very different. There are fear of thoughts of self-exit versus actual thoughts of self-exit. She said say a patient might say they're having self-exit thoughts. But when they describe them they're not actual self-exit thoughts. They're fears of self-exit. So that's the difference. And I'm sorry I think I forgot exactly what your question was. Reddington points out more notes from Tufts near December where Lindsey denies to Tufts that she feels like she wants to self-exit but she feels close to feeling suicidal. Reddington asks so she was dwelling on it or thinking about it, right? Is that fair? She was fearful of eventually having those kinds of thoughts to self-exit. Yes. And how frequently were those thoughts? I'm not sure exactly how frequent they were. Did you ask her? It's very likely that I did ask her frequency. But they're not in the notes. Would that be in your medical records when you see some patients, you have some patients other than Lindsey Clancy at that point, right? Yes. And you document when a patient, my god, when a patient comes in and tells you that she's postpartum distress and she's close to having self-exit thoughts to self-exit. That's important, isn't it? It's important that I'm aware that she's having these thoughts. What thoughts? That she is fearful to become suicidal. And she told you I imagine or you asked how frequently these thoughts were. I don't have that documented how frequently they were but it is a question that I usually ask when we're talking about self-exit thoughts. When we're usually testifying in a murder case, we usually have facts that we can tell the jury not speculation. Objection sustained. Would you agree with me that many times patients, especially psychiatric patients, may minimize their symptomology? Patients sometimes do. And sometimes when a woman that has just had a child and other little kids at home, you feel worried about the government taking the kids away from them because you're a mandated reporter, aren't you? Objection over world. You're a mandated reporter, aren't you? I am. She says having self-exit thoughts alone is not a reportable condition. Doctors said that. Yeah. We don't know how frequently she was having them, yeah? Today, I don't know how frequently but at that point, I believe I did know how frequently. Tough student know that Lindsey called the self exit hotline twice during this time frame nor did she ever ask about it. Reading ten asks, "Is it a surprise to know that she called the hotline in that time frame not once, but twice and was turned away?" You guys were on the front line of this, weren't you? It does surprise me, yes. What do you mean, "turned away"? This is where a lot of people are upset with the system, but even that is a larger conversation. You can have thoughts of self-exit, but typically you are not taken in on a psychiatric hold unless you have a plan. Okay. So, she called and they just. I guess they tried to talk her through it, right? Ah, I see, I see. That's what he meant by "turned away". Yeah. She wasn't taken in, and I see. And you never asked if she ever called a hotline, did you? I don't think that I did. Now, there is debate online of whether this is more of a problem with the field of how psychiatry is practiced, or if it's a Dr. Tufts problem. But Reddington is asking Dr. Tufts about how Lindsay told Tufts that she's feeling like self-exiting and Tufts says, "I asked her, so what do you mean when you say I'm feeling self-exit, like suicidal?" And that's when she said, "It means I'm feeling hopeless, and then I ask, do you have intention of harming yourself? Do you have a plan of hurting yourself?" And she denied those. Which Reddington later asked, "What's the difference?" And Tufts says, "A plan means that they know exactly what they're going to do to do the plan, what they're going to use, maybe when they've researched it, and that presents an immediate threat, and that is something that would require hospitalization." Which now, a lot of people argue it's just semantics, and of course, no one is going to risk being sectioned by saying, "Yes, I have exact plans." And also, a lot of self-exits are not meticulously planned either, in fact, I think statistics show that most of the time that they are not planned, but again, does that fall on Tufts or does that fall on the guidelines that are put in place? But what would be the better alternative? Because I don't think that we should also just leave it fully up to the provider's full discretion whether or not a patient is sectioned because for their own malpractice, they would just start sectioning fucking everybody. And that would also be very dangerous and could result in worse outcomes. So we could go in circles in point shoes, but I just don't know if we would end up in the same spot, and I don't think that I'm equipped because I have no experience in health care to even really understand the full scope. But that is a full conversation that's happening online. Readington asks Tufts, "Now, you'd agree with me at this point prior to the next appointment, which was November 2nd, that Iga had gotten significantly worse, even after all this medication that you've been prescribing, right? Did you make a note that she was telling you that she had depression and that she was crying, had more anxiety, and saw Amnea had increased brain fog, and worrying about self-exit. In the couple of weeks after starting this medicines, I don't recall that the symptoms were significantly exacerbated." Okay, and did she tell you about intrusive thoughts that she was having? And what were those intrusive thoughts? It was the feeling like I'm going to die. And this is where I guess people have some, this is also another nuanced debate. Some people think that Tufts comes off really cold, okay, this is aside from the medications. Some people think that Tufts comes off really cold and does not do enough to help Lindsay. Other people argue that Tufts is a psychiatrist, so she really is a prescriber of medication. She's less of a talk therapy. Tufts does recommend Lindsay to a few therapists that she could talk to. So there is like this back and forth of people, was it really her job, and this is the line of questioning that kind of sparks that debate. Reddington asks, "You indicated that she can't sleep. She's panicking. She had worse depression and intrusive thoughts. She was numb. Nothing mattered." I feel like I'm going to die. Denies SI, but SI is suicide ideation. Denies SI, but quote, "Yesterday, close to it, feeling hopeless. Did you give her therapy and validations after she told you that?" I believe I did. What did you do? You got a woman that's telling you that she's hopeless. She doesn't care if she dies. Can't sleep. What did you do to validate her on your therapy? I told her that this is something that we could address, that there was hope, that there were treatments, there were different types of treatment programs that are more supportive like partial hospitalization programs. You agree that she had, in your opinion, a severe mental disturbance at that point that was manifesting itself? She had moderate and moderate heading towards severe. So this is where people are like, "Okay, well, if you're in a really bad state and someone's telling you, don't give up, there's hope." That would also send you into a spiral, but then others are arguing, "Yeah, but she is a psychiatrist." And like, a lot of people are like, "I only see my psychiatrist like once a month." And she asked me three questions of like, "How are the meds? Great. Okay, prescribing another one. Sounds good. So people are saying, like, "Are we looking for the wrong things with the wrong providers?" There's a lot of debate to be had. Other people are saying, "Heinzide is 2020." And she only seems heartless now, but these are how all psychiatrists are. And if you have a problem with that, you probably have a problem with psychiatry. But it's, I don't know. One interesting aspect though, I think that does not get talked about enough, is that Lindsay stated to Dr. Tuss that she was having about one to two alcoholic beverages about five times a week, which is quite a bit considering she does have an out-of-an-PRN prescription. You cannot make Spencer Diasopines with alcohol. Oh, and she told the doctors that? But I imagine it's just, like, brushed up on Tuffs mentioned that she did not see a problem with that, but I would imagine that Tuffs was telling her, like, "You can't take Benzo's with alcohol." But I mean, some people think that is a lot of alcoholic beverages, and maybe she was self-medicating through alcohol to stop with the anxiety, but it's just not a bigger topic, which is why we don't get much clarity, but it is kind of weird. But people are ultimately divided on how they feel about Dr. Tuffs. Her care for Lindsay, her treatment decisions, her testimony, her court demeanor, there are a lot of people who defend Tuffs saying, "Tuffs spent more time with her than lots of doctors who get sued." So, another writes, "The worst is knowing that all these providers actually legitimately try to help Lindsay. It's not like an obvious case of medical gaslighting or malpractice." Another person says, "Dr. Tuffs was not negligent if you're dealing with a patient who is non-compliant and takes some pills here and there and some pills there who doesn't give the different prescriptions enough time to become effective is not forthcoming with everything, that's not the psychiatrist's fault." Other comments that it's weird to defend Tuffs, they write, "Lindsay exhibited signs of bipolar." So, people are saying, like, everyone's getting lost in all the testimony when the one thing that people should be worried about is that after Zoloft, Lindsay was exhibiting signs of bipolar. But others argue there were no contemporaneous signs that Lindsay was exhibiting symptoms of mania. It's up for debate, but they write, "Lindsay exhibited signs of bipolar and Tuffs completely missed it." Not only did she continue feeding her medicine that counteracts with bipolar, but she let the illness go and treat it as well. This is literally the equivalent of not treating cancer because you don't detect it. Her mental illness grew faster and stronger without proper medication and the incorrect meds is sickening to hear people say she did her best. Three babies died and a woman is paralyzed, her best was not even close enough. Another thing is a lot of people in healthcare do point out that you have to be extra cautious when someone is postpartum because very quick way to activate a manic state is sleep deprivation. And you're going to have a lot of sleep deprivation when you have a baby. Yeah, and they're all sleep deprived. And a lot of times people who give birth and then have bipolar episodes afterwards, they are not what is very obvious signs of bipolar manic episodes. They're usually in a mixed state, so it can easily be confused with postpartum depression. Another person in the residency subreddit points out that while they have sympathy for Tufts, they do think that there's a lot to learn from the way that she takes notes, her medical notes that were used in court. The fact that Tufts also wrote that Lindsay was "close to SI." They think it's really bad because either you have SI or you don't, that could be legally used against you. Or if someone is "close to SI," that's a very insufficient description. You have to back it up with more notes. They also state that they understand why the general public who is not in psychiatry is not sympathetic towards Tufts. But while they are sympathetic, they can see easily why the general public is not. They think that she appeared grossly unprepared for cross-examination. An example being, you know, when questioned on why telehealth only and why she has never met Lindsay in real life, Dr. Tufts should have highlighted that it makes psychiatric care more accessible for a busy mom with three children. She did not answer any of those questions well. But another highlighted example is later, Dr. Tufts, she's asked about one of the notes about pressured speech. We're going to get into it in this episode, but she says, "Tu, Reddington, I don't care what was written, I know what I meant." So she has a lot of these moments where her notes are not good enough and she's almost defensive about her own notes and that could be the stress of the lawsuit and her career at risk. Right? Now, I can't tell you the exact data points, obviously. But it appears that a lot of therapist physicians, psychiatrists, healthcare forums, with practicing providers, they either feel like a little too somewhat too fully sympathetic for Dr. Tufts. They don't think that she did everything perfectly, but they can see how it happened. Knowing the healthcare system, knowing how these things work, they don't necessarily think that she should be sued for malpractice, but they think her documentation was horrendous and that people need to learn from that. and her preparation for the cross-examination. examination was also horrendous. They also critique a lot of the system rather than tuffs herself. Others are more focused just on the system as a whole saying, this shows what's wrong. Doctors are incentivized to prescribe medication, have quick visits and pass blame to others. What is shame? Others believe that tuffs, whether you like her or not and whether she did make small mistakes that are not negligence, not enough for a malpractice suit, they think that more of the hate should be on the system rather than the provider itself is what some people are saying. One person writes, it became very clear to me when watching her testimony that this was not negligence and rather a clinician who was operating within the constraints of the system. Given imperfect information, difficult to detect presentation, treating a patient who's engagement and medication decisions were changing. However, a lot of people in psychiatry point out, no, there's some bad here. So the first being that Lindsay later has a lot of other providers. And none of them are talking to each other. I wouldn't say none, but the most important ones are not talking to each other. - So how did that happen? Is it just how the system is set up? - Yes, so Lindsay goes and sees another provider who is also prescribing. And then Lindsay goes and tells Tuffs, oh, my other provider just prescribed me this and this and this and like, what do you think, right? It would make the most sense for Tuffs to then say, hey, can you fill this form so I can get the records from that provider? And maybe I can even talk to that provider so that we can be on the same plan for the same treatment plan, right? She never does that. She just takes Lindsay's word for it. And the other provider equally does the same thing. - Interesting. Is that like a common practice? Is that? - That's up for debate. So a lot of people on the healthcare forum say, this is incredibly common. - Wow. - Other people say, it's, some people say it's like a hindsight is 2020. - Wait, so they don't share their medical charts, their histories and all of that? - No, unless you're in the same system. So the few people that do communicate with each other, they're in the same healthcare system. So they have the same, like they both work at the same hospital. So they have access to the other provider. - That's so interesting. Because like even when we take mango to the vet, they have to get their records, no? - Yeah, yeah, you have to get, but you have to sign the release forms. And I think the point that Reddington is pointing out is that toughs never even had Lindsay sign the release forms. And then other psychiatrists are saying, it's really not the craziest thing. Like it's kind of pretty common to know that SSRIs, that type of response does point towards a mixed bipolar depressive state. However, they also argue the distinction can be really hard when everyone responds to medications differently and maybe she was not showing signs of mania as much. So it's still up in the air, but others are saying, you know, that's a pretty common knowledge is like, oh, we should be working, looking out for this. But others just focus on the fact that, listen, she admittedly did not have specialized training in perinatal mood disorders. It was inappropriate to advertise herself as having some sort of specialty or even interest in it. This alone deserves a lawsuit. Another person writes, she is aware that her notes are medical records, right? Dr. Tufts continues to see Lindsay throughout September, October, November, December, and ultimately January. Her last appointment with Lindsay is January 23rd, the day before the incident. And one of Tufts' notes will be argued and dissected in court, but first, we have to go through all the other providers that Lindsay had seen in that timeframe. And that is where I leave you with the first half of this episode. Let me know your thoughts. The second half of this episode will be up for the audio podcast very quickly. And let me know your thoughts. Stay safe, and I will see you in the second half. (gentle music) (gentle music)