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Who is Julie Paul? Psychiatric nurse reveals Lindsay Clancy's worsening symptoms & medication issues, ‘She was really…’
Lindsay Clancy was evaluated for severe anxiety at South Shore Hospital. Psychiatric nurse Julie Paul reported Clancy's struggles with medication management.
Lindsay Clancy's evaluation at the Perinatal Behavioral Health Program of South Shore Hospital revealed that she was suffering from "extreme" anxiety, as per Julie Paul, a psychiatric nurse practitioner who provided her care in November 2022.
Lindsay Clancy showed no signs of suicidality, says Julie Paul
Paul testified that Clancy achieved a score of 23 out of 30 on the Edinburgh Postnatal Depression Scale. However, it is important to note that she did not exhibit any signs of suicidality.
In 2018, Paul established the Perinatal Behavioral Health Program and shared that she met Clancy in late November through the former's then-mother-in-law, Sue, who was also a nurse at South Shore Hospital. Paul testified that she contacted Clancy, who had given birth to her third child around six months ago, and assessed that Clancy would be a suitable candidate for the perinatal program.
“She said she did really well for the first 12 weeks [after giving birth]. She was excited, really happy,” Paul recalled in the court. “And then when Patrick [Clancy’s then-husband] went back to work, she said she started to struggle with some anxiety.”
Clancy had been receiving treatment from a psychiatrist, Dr. Jennifer Tufts, and had experimented with several psychiatric medications, achieving mixed results. Paul noted that Clancy had also gone to the emergency room at South Shore Hospital a few days earlier, on November 16, 2022.
“I asked her specifically if she felt like she wanted to harm herself or her children, and she said no,” Paul said.
Lindsay Clancy denied ‘experiencing any auditory or visual hallucinations’
She stated that Clancy also refuted experiencing any auditory or visual hallucinations at that time. The young mother additionally mentioned facing anxiety after the birth of her second child, as Paul recalled.
When asked if Clancy had managed that previous episode of anxiety without medication, Paul responded, "as far as what I was told, yes."
However, Tufts had previously testified that Clancy had briefly attempted to use the antidepressant Zoloft following her second pregnancy.
Prozac and Ativan was prescribed to Clancy
Paul informed the jurors that she chose to initiate Clancy on the antidepressant Prozac, which Clancy had been prescribed during her nursing school years. She clarified that Prozac may temporarily exacerbate anxiety before alleviating symptoms, thus she decided to combine it with Ativan, a benzodiazepine, to ensure Clancy's comfort and ability to sleep.
In response to a query from the prosecutors, Paul clarified that side effects typically manifest within the initial week or two of taking Prozac, while it usually requires four to six weeks for patients to experience improvement. Clancy expressed apprehension about beginning Prozac, prompting Paul to testify that he urged Clancy to adhere to the prescribed treatment plan.
From Prozac to Ambien, mirtazapine and Klonopin
On November 25, 2022, just three days after starting Prozac, Clancy expressed to Paul that she was struggling to tolerate the medication and felt disconnected and "out of it."
Paul testified that she decided to stop the Prozac and instead prescribed a one-time dose of Ambien to assist Clancy with sleep, in addition to a prescription for mirtazapine, also known as Remeron, which is another antidepressant that is particularly effective for sedation and anxiety. She combined these medications with Klonopin, a longer-acting benzodiazepine designed to aid Clancy in managing her sleep and anxiety as she began the new antidepressant.
Paul also mentioned that she cautioned Clancy against the simultaneous use of Ativan and Klonopin. She further stated that Clancy was "really anxious" about the possibility of becoming dependent on benzodiazepines.
When asked about her concerns regarding Clancy discontinuing Prozac after just three days, Paul responded, "When a client lacks commitment to the medication, it is detrimental. Its effectiveness diminishes."
“I was collaborating with Lindsay to identify a medication that would enhance her comfort. She was experiencing significant discomfort and anxiety. The Prozac was not being well tolerated due to the activation it caused,” she added.
Why did Paul transfer Clancy’s care to another provider?
Paul acknowledged that it is "pretty common practice" in psychiatry to experiment with various medications to identify the most suitable one for a specific patient. She also suggested that Clancy explore a partial hospitalization program at Rhode Island’s Women & Infants Hospital Center for Women’s Behavioral Health. However, Clancy believed at that time that it would not be feasible for her family.
Paul informed the jurors that she eventually transferred Clancy’s care to another provider on November 30, 2022, as she was already in the process of relocating out of state and leaving her position.
