![\"Lindsay](\"https:\/\/www.europesays.com\/uk\/wp-content\/uploads\/2026\/08\/1786604812_88_0x0.jpg\")
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Lindsay Clancy in Plymouth Superior Court in Plymouth, Mass. <\/p>\n
USA Today 2026<\/p>\n
A Massachusetts courtroom has confronted one of medicine\u2019s most misunderstood conditions.<\/p>\n
Lindsay Clancy is on trial for the murder of her three children in her Duxbury home in January 2023. Her defense argues she was in the grip of postpartum psychosis, a rare and catastrophic psychiatric emergency, at the time of the killings; prosecutors counter that her actions were deliberate. Whatever the jury decides, the case has exposed a gap in public and clinical understanding of postpartum psychosis itself \u2014 what it actually is, how it is different from the conditions most commonly associated with pregnancy and why that confusion carries real consequences for mothers and children.<\/p>\n
To better understand the diagnosis and management of mental health conditions associated with pregnancy, I spoke with Dr. Patricia De Marco Centeno, a board-certified consultation-liaison and reproductive psychiatrist. Here, we discuss the terminology, and in a subsequent article we cover the challenges of treating these conditions.<\/p>\n
Headshot of Dr. Patricia De Marco Centeno<\/p>\n
Dr. Patricia De Marco Centeno,Understanding Maternal Mental Health Terminology<\/p>\n
The umbrella term now used is perinatal mood and anxiety disorders, or PMADs \u2014 a category that captures depression, anxiety and obsessive-compulsive disorder that can emerge anywhere from early pregnancy through the first year postpartum. Centeno clarified that in the field of reproductive psychiatry, clinicians have largely moved away from postpartum depression as a term in favor of perinatal depression, “since depression frequently begins during pregnancy, not just after, or ‘post,’ delivery.”<\/p>\n
Most of what falls under PMADs is common and comparatively benign: postpartum blues, a well-recognized clinical phenomenon affecting up to 80% of new mothers, presents as roughly two weeks of tearfulness or irritability that doesn\u2019t significantly obstruct bonding or daily function. Two other conditions \u2014 perinatal depression and perinatal obsessive-compulsive disorder \u2014 also sit squarely inside the PMAD umbrella. <\/p>\n
What Is Perinatal Depression?<\/p>\n
Perinatal depression looks like profound low mood, tearfulness or irritability, along with changes in sleep and appetite that aren\u2019t fully explained by the demands of caring for a newborn. Centeno especially looks for a sense of hopelessness \u2014 where patients express a feeling that there\u2019s no way out, or no improvement coming \u2014 as the marker that symptoms have crossed from ordinary adjustment into something that needs treatment.<\/p>\n
“The clearest diagnostic signal isn\u2019t symptoms lasting beyond the two-week cutoff of ‘postpartum blues,\u2019 but functional impairment: a mother who can no longer carry out her daily activities, or care for herself or her baby, the way she could before,” Centeno says. Perinatal depression, she adds, affects up to one in five women<\/a>, rarely poses any danger to the infant and responds well to standard treatment.<\/p>\n What Is Perinatal Obsessive-Compulsive Disorder?<\/p>\n Obsessive-compulsive traits are common in the perinatal period and present as contamination fears, excessive cleaning or checking and intrusive thoughts centered on the fear of accidentally harming the baby. Centeno is careful with the term, however: “It is very rare that somebody meets full criteria for obsessive compulsive disorder.” Most mothers are experiencing a flare of OCD-like traits, not the diagnosable disorder itself, though the perinatal period is unique in how strongly it can trigger them.<\/p>\n The quintessential example, according to Centeno: “I\u2019m gonna drop the baby.” These thoughts are egodystonic \u2014 incongruent with the mother\u2019s own values and self-image \u2014 which is exactly why they’re so disturbing to her, not because she has any intent to act on them. The diagnosis of perinatal OCD comes with no signs of psychosis: no delusions, no hallucinations, no disorganized behavior.<\/p>\n Mothers with perinatal depression and OCD know something is wrong, Centeno says \u2014 they\u2019re often crying, afraid or hesitant to speak up for fear of how the thoughts will be interpreted, but they recognize the thought as a symptom, not a plan.<\/p>\n The most interesting point Centeno raised is the term anosognosia: “Mothers with psychosis do not have insight, and this is not intentional. It\u2019s simply a neurological condition in which you do not know that you\u2019re ill.” That distinction \u2014 insight versus its absence \u2014 is where perinatal OCD and depression part ways from postpartum psychosis.<\/p>\n What Is Postpartum Psychosis?<\/p>\n