Lindsay Clancy Case: The Warning Signs of Postpartum Psychosis | Dr. Blair Steele & Dr. Kenneth Spielvogel

We're Out of Time

This episode of 'We're Out of Time' examines the tragic case of Lindsay Clancy through the lens of postpartum psychosis, featuring experts D

Key takeaways

• Postpartum psychosis is a rare but severe condition affecting 1-2 per 1,000 births, characterized by sudden onset and psychotic features like hallucinations or delusions.
• It differs from postpartum depression by including psychotic symptoms such as command hallucinations and loss of insight, even when the individual appears functional.

Main topics

• Postpartum psychosis vs. postpartum depression
• Warning signs of postpartum psychosis

Notable quotes

"It's a perfect storm. You have hormone withdrawal, sleep deprivation, and pre-existing mental illness." – Dr. Kenneth Spielvogel

Conclusion

The episode underscores the urgent need for better education, early intervention, and

Transcript preview

Speaker 5 (0:00) That is so tragic. It irks all of us. We feel it in every cell of our bodies. But if we just judge it, we're not going to learn anything. It's important that we're curious what could bring someone to do something like this. It's the only way we'll get some information and hopefully be more preventative in the future. Speaker 2 (0:34) If someone has a problem with substance use disorder, please call One Call Placement. That's 888-831-1581. And if we can't help you, we'll make a referral to someone who can. Please, Speaker 3 (0:47) we're out of time. Speaker 2 (0:49) One Call Placement is affiliated with Carrera Treatment Wellness and Spa and One Method Treatment Centers. Speaker 3 (0:55) Before we start the conversation today, I want to deliver a personal message. Every day, families across America lose someone they love to an overdose. Many of those deaths are preventable when communities have the right education, resources, and support. That's why I've partnered with the CDC Foundation through their COPE, Community Overdose Prevention Efforts campaign, and committed to matching every donation dollar for dollar up to $25,000. I've spent my life helping people recover from addiction, but if we can get to the place of prevention first, this would help save so many more lives. I hope you'll join me in supporting the CDC Foundation's overdose prevention work. at cdcfoundation.org slash cope. You can also visit the link below in the show notes to donate. Thank you from the bottom of my heart. The Lindsay Clancy trial has ended without a verdict after a deadlocked jury led to a mistrial. Regardless of what happens next in this courtroom, this case has put postpartum psychosis into the national spotlight. What is it? What are the warning signs? What do families need to know before a situation becomes a crisis? I'm joined by two of our experts at Carrera Treatment, psychologist Dr. Blair Steele. and Dr. Kenneth Spielvogel, who spent nearly 30 years as an OBGYN and now works in addiction medicine. They're here to help us understand what postpartum psychosis really looks like, what they've seen in their clinical work, and what families and loved ones need to know when Speaker 4 (2:45) someone may be in danger. Blair, Kenny, welcome to We're Out of Time. Speaker 3 (2:49) Let's start with the most important. important basic question. What is postpartum psychosis? Speaker 5 (2:57) Postpartum psychosis is a severe and sudden mental health condition that can occur. I want to say it's one to two out of every 1,000. We could fact check that. Births. And it's very serious. And it could be very sudden. And unfortunately, tragedies like the Lindsay Clancy case are just highlighting a lot of gaps in information and gaps in care. Speaker 3 (3:27) Kenny, you Speaker 4 (3:28) got a comment? I Speaker 3 (3:29) can Speaker 4 (3:29) add a little more. I think it's best if we're going to look at that to define postpartum depression versus postpartum psychosis. So postpartum depression is relatively common. It's 7 to 10 % of all women postpartum. It's defined as starting any time within that peripartum period, which is before birth and then after birth. Generally, it honestly is a... Formal definition, the DSM criteria of up to four weeks postpartum, which I think in this case is particularly kind of important when they're going to look at it legally. Postpartum depression is generally more common in women with a history of postpartum depression, history of other comorbidities such as bipolar or major depression. It is without. Speaker 4 (4:21) any kind of psychotic features, which is what pushes us into postpartum psychosis, which is generally auditory hallucination, visual hallucinations, a dissociation without insight into their disease. So those are some really clear distinctions between the two. So, I mean, it's a tragic case. It's, I think, why it has the public's attention. is for a variety of reasons, nevermind just the death of three children at the hands of their mother. Also in combination with the idea that she attempted to kill herself in the aftermath of it. That's shocking enough as it is obviously to draw people in. But on top of that, this woman was a labor and delivery nurse. So she had had a history of postpartum depression in two previous pregnancies. In this pregnancy after delivery, and this occurred She actually killed her children eight months. The youngest child was eight months old. So she had been in and out of several hospitals. She had been on up to, I believe, up to like 50 antipsychotic and antidepressant type medications. She was constantly having relapses. She reported auditory hallucinations. And even a, you know, a drive and intent voice telling her to kill her children. And Speaker 3 (5:47) this was all prior to killing the children. Speaker 4 (5:50) Yeah. And Speaker 3 (5:51) it's all documented. Speaker 4 (5:53) Well, it's interesting. So one of the things that's difficult to point is the day before the crime, she saw her psychiatrist and in their medical notes, it said. Again, we know how well doctors document for the most part, which is not very good. Speaker 2 (6:11) But Speaker 4 (6:11) there is a comment of no evidence of psychotic features. Speaker 3 (6:20) Did they talk to the guy? Speaker 4 (6:23) Yeah, I mean, he was deposed in the course of the trial. I have not, to be full disclosure, I have not watched any of the footage or, you know, much of the, you know, day-to-day coverage of the trial. But this is all through reading. Speaker 3 (6:37) Yeah, either of I. It did say that she went to doctors for years complaining of these problems, right? Speaker 4 (6:45) Yeah. Yeah. I mean, she had severe postpartum depression in two pregnancies before. Speaker 4 (6:53) And elements of postpartum psychosis in this one. Where was the husband? Speaker 4 (6:59) He she sent him out. So this is where it really gets tripped up. She sent him out for food on errands and then did this. So they're saying she premeditated. Therefore, she couldn't have been psychotic, which is ridiculous. You can be that's you can be psychotic and still, you know, have a plan about what you're going to do around that psychosis. OK. All right. Do you not agree, Blair? Speaker 5 (7:27) I do agree. Speaker 4 (7:28) Yeah. Speaker 3 (7:29) Dr. Spiel Vogel from the medical side. What is happening to a woman's body after she gives birth? People casually say her hormones are all over the place. What does that actually Speaker 4 (7:43) mean? I mean, that's that sounds like a definition written by a man to describe a woman. Speaker 4 (7:51) Her hormones are all over the place. I mean, what happens? You have a complete disruption of day-to-day routine. You have obvious sleep deprivation, depending on the mode of delivery, C-section versus vaginal delivery. You know, what elements of healing as a result of vaginal laceration after vaginal delivery, all these things that are going to cause physical affectation. Then on top of that, you know, you have a severe hormone withdrawal. You know, not only you get periodic releases of oxytocin, you get withdrawal of progesterone, withdrawal of estrogen. On top of that, when you already have pre-existing mental illness, it's a perfect storm. Speaker 3 (8:39) Okay. Well, you're an OBGYN by trade. Let's ask an actual woman. You got anything on this, Blair? Speaker 5 (8:47) It's everything that Kenny said on a physiological level on top of so many psychosocial changes that are happening. Identity is that question. I've personally found early motherhood very isolating. No one told me about that. You know, for the first week or two, people are coming. They're coming to the hospital. They're bringing you food. And then it gets very quiet, particularly if you're used to working, if you have all sorts of purpose and functionality throughout the day. It can be sad on top of the fact that you're told how you're supposed to be feeling. You're supposed to be glowing. You're supposed to be happy. Now, also take into account that you may have other children, their schedules, their busyness. It's a very complicated time. And I think systemically, it raises a lot of issues and challenges. All Speaker 3 (9:40) right. How does hormone severe sleep loss and conditions like bipolar disorder combine to trigger a psychiatric emergency? Speaker 5 (9:50) If this is for me, I will say I will piggyback on it being the perfect storm. If you had any experience of this prior, the likelihood of something like this becoming more harmful to you postpartum is much greater. So if you had some depression prior or bipolar, which is more severe prior, it is just about exponential that postpartum will put you in a vulnerable place. We also don't know what kind of medications you can or cannot take while you're pregnant. So that's going to have a variable within it. You'll have to alter things accordingly. Speaker 5 (10:30) The lack of sleep. Now, I want to just point something out with postpartum psychosis. It's not just the baby was up, the baby was nursing, I'm not sleeping well. Characteristically of this is an insomnia where the person feels energized. I'm not tired. So hasn't slept in days and also feels like I don't need to sleep. That's a distinction. Speaker 3 (10:51) So you're saying that they haven't slept in a number of days and they're not tired. And that is a symptom of what? Speaker 5 (11:00) Of the postpartum psychosis. That's what's going to distinguish what's happening into that more psychotic feature than would your standard sleep deprivation, which comes inevitably with having a newborn. Speaker 4 (11:16) Yeah, the severe insomnia is really one of the early warning signs of postpartum psychosis. And again, when you think about if the largest group is going to be bipolars and it pushes them into it, like Blair said, a manic-like state. So the sleep deprivation leads to, it pushes them almost into a mania, but then it also rapid cycles them into severe depression with psychotic features, hallucinations, auditory, sometimes visual delusions. you know, fix false beliefs, you know, the command hallucinations as well, too. How Speaker 3 (11:52) long have you been a doctor, Kenny? Speaker 4 (11:56) 30 plus years as an OBGYN. Speaker 3 (11:59) And you started off being an OBGYN, right? Speaker 4 (12:02) Correct. Speaker 3 (12:03) Okay. So you've been doing this a long time and you are the beginning and the end in this industry. Please tell me one time where somebody with postpartum depression or psychosis has ever harmed their child. Speaker 4 (12:19) Oh, I've definitely seen it. I've probably seen like attempted suffocation five times. Really? So Speaker 3 (12:29) it's a thing. Yes. And. Speaker 3 (12:35) Did those people ever get well? Do you know what? Take me through one of those cases. Speaker 4 (12:42) I'll tell you something just for your listeners as well, too. If you want to see an amazing movie that really dives into the postpartum psychosis element. I don't know if Blair's seen it, but it's called Night Bitch and it's starring. Have you seen that, Blair? Speaker 5 (12:59) I haven't. Oh, my Speaker 4 (13:00) God. It's so good. And this woman actually starts to believe that she's a dog. And the movie does an amazing artistic job of making the viewer not sure if she's actually becoming a dog at night or this is truly a psychotic episode. I mean, in cases that I've seen that are incredibly tragic, it starts out literally with like it's. pretty much textbook, the one that I'm thinking about in particular, where severe insomnia, you're trying to treat the insomnia, a history of mental illness, a history of postpartum depression that just amps itself up. And it wasn't like, you know, a suffocation to the point of follow through. I saw no infant side in the course of my career, thank God. But um, a point of just literally snapping, holding a pillow over a baby and then snapping out of it. Thank God, whether the husband was there or a nanny or whoever else. But, um, yeah, I mean, sleep deprivation in and of itself can cause psychosis, nevermind all the other elements that go along with it. Speaker 3 (14:10) Blair, have you ever heard of this before? Truthfully, have you ever, do you know of any friends? Do you read anything? Speaker 5 (14:16) Of course. Of course. In fact, when I had my two babies, I was asked a screening question when I would go to my follow-up appointments about if I'm feeling sad or if I'm having any thoughts. So there was some screening. I mean, there's definitely not a gap. And I would even say similar to autism, it's not that it's happening more often. It's just that the diagnostic criteria is becoming more understood, more spoken about. Women are talking to one another through social media and other venues about these things that were typically hush-hush and held close to the chest. Speaker 4 (14:53) I can add something as well, too. Can I add something? I'm sorry to interrupt you, Richard. Of course, no. The American College OBGYN ACOG, in the previous time, we used to deliver someone and say, okay, we'll see you in six weeks after a vaginal delivery, six to eight weeks postpartum for a physician check-in. Due to the increase... in postpartum depression and postpartum psychosis, we move that back to two to three weeks for a check-in, whether it's telehealth or an in-person check-in or home visits. So home visits