Lindsay Clancy, accused of strangling her three children, including her eight-month-old infant, in the family basement with an exercise band before jumping out of an upstairs window and paralyzing herself in a botched suicide attempt, did everything “right.”
She felt anxious, sad, and detached from herself, and all of the many feelings that are known to accompany postpartum depression and/or postpartum psychosis.
To help herself, she consulted the Experts™, the trusted professionals of the psychiatry profession.
In providing the help that Clancy so desperately needed, they, over the course of about four months, with no coordination with one another, put her on 13 potent psychiatric drugs with known negative drug interactions between them (more on that in a moment).
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Via Boston Globe (emphasis added):
When she allegedly strangled her three children inside their Duxbury home last week, Lindsay Clancy was in the throes of homicidal and suicidal thoughts brought on by overmedication of drugs prescribed for mood disorders, anxiety, and psychosis, her new defense lawyer, Kevin J. Reddington, said.
“One of the major issues here is the horrific overmedication of drugs that caused homicidal ideation, suicidal ideation,” Reddington said in an extensive interview Thursday evening. “They [Lindsay and her husband Patrick] went to doctors repeatedly saying ‘Please help us.’ This was turning her into a zombie ...the medications that were prescribed were over the top, absolutely over the top.”…
Between October and January, Lindsay Clancy was prescribed 13 psychiatric medications in all, Reddington said.
They were: zolpidem, sold under the brand name Ambien; clonazepam, sold under the brand name Klonopin; diazepam, sold under the brand name Valium; fluoxetine, sold under the brand name Prozac; lamotrigine, sold under the brand name Lamictil; lorazepam, sold under the brand name Ativan; mirtazapine, sold under the brand name Remeron; quetiapine fumarate, sold under the brand name Seroquel; sertaline, sold under the brand name Zoloft, along with trazodone, hydroxyzine, amitriptyline and buspirone, he said.
But don’t take the lawyer’s word for it.
Here’s a brutal rundown, directed by Clancy’s lawyer in the interrogation of one of her providers, of the drugs she gave her patient — prescription after prescription after prescription, even while Clancy protested that they made her “feel like a zombie” and develop “dark thoughts.”
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Any one of these medications on their own is known to have potentially serious side effects, including the ones that afflicted Clancy.
Together, they have numerous serious potential side effects.
Potential interactions of these drugs, from ChatGPT:
There are several potentially important interactions among the drugs on the list, particularly if some were taken concurrently. But it is important not to infer from the existence of interactions that a particular combination did cause a particular symptom or behavior in Lindsay Clancy. That requires knowing the exact drugs, doses, timing, blood levels, and clinical circumstances.
The most significant potential issues are:
1. Multiple sedating/CNS-depressant drugs
This is probably the most obvious interaction category.
Several of the drugs you listed can depress the central nervous system:
- Lorazepam (Ativan)
- Clonazepam (Klonopin)
- Diazepam (Valium)
- Zolpidem (Ambien)
- Quetiapine (Seroquel)
- Mirtazapine (Remeron)
- Trazodone
- Hydroxyzine
- Diphenhydramine (Benadryl)
Taking multiple such drugs together can potentially produce additive sedation, impaired coordination, confusion, cognitive impairment and, at sufficiently high exposures, respiratory depression. The FDA specifically warns that zolpidem's CNS-depressant effects can be increased when it is combined with other CNS depressants.
The benzodiazepines are particularly relevant because Ativan, Klonopin and Valium are all benzodiazepines. They aren't three unrelated medications; they belong to the same pharmacological class.
2. Fluoxetine + amitriptyline
This is a particularly important pharmacokinetic interaction.
Fluoxetine (Prozac) strongly inhibits the CYP2D6 enzyme. Amitriptyline is metabolized in part through CYP2D6. Consequently, fluoxetine can substantially increase concentrations of tricyclic antidepressants.
The FDA labeling for fluoxetine reports that concentrations of certain TCAs increased more than twofold to as much as tenfold when combined with fluoxetine, and recommends dose reduction/monitoring.
There's another important complication: fluoxetine has a very long half-life, and its interaction potential can persist for weeks after discontinuation.
So if Clancy had recently been taking fluoxetine when amitriptyline was started, that could be pharmacologically significant.
3. Multiple serotonergic drugs → serotonin syndrome risk
Several medications in the list affect serotonin:
- Sertraline
- Fluoxetine
- Trazodone
- Buspirone
- Amitriptyline
- Possibly other combinations depending on what was actually being taken simultaneously
Combining serotonergic medications can increase the risk of serotonin syndrome, a potentially serious condition characterized by symptoms such as agitation, confusion, sweating, tremor, hyperreflexia, fever and, in severe cases, seizures or cardiovascular instability.
This doesn't mean that simply having prescriptions for these drugs creates serotonin syndrome. The timing and concurrent use matter enormously.
4. Fluoxetine + diazepam
There is also a documented interaction between Prozac and Valium. Fluoxetine can prolong diazepam's half-life, potentially causing diazepam to remain in the body longer. The FDA labeling specifically identifies this interaction.
That could be relevant when considering cumulative sedation if diazepam was being used alongside other sedatives.
5. Quetiapine + other drugs that prolong QT
Seroquel (quetiapine) can affect cardiac electrical conduction, particularly the QT interval. Its FDA labeling advises avoiding combinations with other drugs known to prolong QTc.
Fluoxetine can also prolong QT and its FDA labeling advises caution when it is combined with other QT-prolonging drugs.
So quetiapine + fluoxetine represents a potential cardiac-interaction issue, although the actual clinical risk depends heavily on dose, underlying cardiac health, electrolyte levels and other factors.
6. Hydroxyzine + sedatives
Hydroxyzine itself can cause substantial sedation. Combining it with benzodiazepines, zolpidem, quetiapine, trazodone, mirtazapine, etc., can therefore increase overall CNS depression.
And Benadryl (diphenhydramine) is another sedating antihistamine, so hydroxyzine + diphenhydramine would add another layer of sedation/anticholinergic effects.
7. Multiple benzodiazepines
If lorazepam → clonazepam → diazepam were sequential substitutions, that's quite different from taking them simultaneously.
If, however, more than one was being taken concurrently, the pharmacological effects could be additive. All three enhance GABA-A-mediated inhibition and can cause sedation, impaired memory, impaired coordination and psychomotor impairment.
Looking back, in light of what the psychiatry industry did to Clancy, one has to wonder whether the eventual tragedy that befell the family was a foregone conclusion. In any case, it certainly wasn't surprising.
