Nearly 20% of adults in the U.S. take medication for their mental health, according to the U.S. Centers for Disease Control and Prevention, even as CNN’s examination of bespoke and personalized medicine says the system still struggles to identify the right drugs for the people forced to live with them. That’s the basic bargain of the psychiatric apparatus: broad categories, trial and error, and a lot of people left to absorb the damage when the fit is wrong.
Who Gets Managed
The article centers that problem through the Lindsay Clancy murder trial, where mental health professionals who treated her testified that she repeatedly sought changes to dozens of medications prescribed for depression, anxiety and other mental health conditions. The day before she strangled her three children, slashed her wrists and throat, and jumped from a second-story window, the 36-year-old labor and delivery nurse wrote in a note on her phone that “medication stole my motherhood and my life.” Prosecutors briefly showed the note to the jury. That line hangs over the whole case like a warning about what happens when treatment becomes a maze and the person inside it keeps asking for help.
In closing arguments Thursday, Clancy’s attorney said she was overmedicated and not criminally responsible for murdering her children in 2023 because she was in a state of psychosis. He said she had a rare condition called postpartum psychosis, which, when left untreated, carries a higher risk of infanticide and suicide, studies show. “She was reaching out for help, and she was not getting it,” attorney Kevin Riddington said as Clancy nodded. The defense put the failure squarely on the system that was supposed to help her. The state, meanwhile, kept its own machinery moving.
What the System Calls Treatment
Prosecutor Jennifer Sprague said the way Clancy killed her children showed the act was premeditated and that Clancy knew right from wrong, misled her mental health providers and did not take medication as directed. “She knows, as a nurse, the importance of following the instructions of your medications,” Sprague said. Clancy has since sued her doctors, claiming they failed to properly diagnose her and instead “subjected her to a disorganized, uncoordinated course of polypharmacy that exacerbated her condition and precipitated a severe psychotic break,” according to the lawsuit. All the providers previously declined to speak with CNN about ongoing litigation.
That lawsuit matters because it points to the hierarchy at work: doctors prescribe, patients comply, and when the arrangement collapses, the burden lands on the person at the bottom. The article says mental health medications generally fall into four or five major categories, including antidepressants, anti-anxiety medications, mood stabilizers, anticonvulsants, antipsychotics and stimulants. SSRIs such as Celexa, Prozac and Zoloft are described as highly effective, but they can take four to eight weeks to work and can cause side effects such as upset stomach, low sex drive and headaches. Benzodiazepines such as Ativan, Librium, Xanax and Valium can work quickly, but they’re typically prescribed only for a short time because people can become dependent on them and the drugs can have dangerous side effects when the nervous system’s activity drops too low.
The article also says a psychiatrist first conducts a comprehensive evaluation that reviews the person’s medical history, symptoms, substance use, delusions, hallucinations and risk of violence or suicide before choosing a category of medicine. Some patients are reluctant to try medication or stay on it. Goldberg said, “When those organs get sick, their functions go awry, we treat them with medicine. When the brain gets sick, it’s the same. What does the brain do? It thinks. It processes information, sensation, motivation, emotion, urges, and those functions can go awry.”
The Promise and the Limits
Dr. Joseph Goldberg, a psychiatrist and psychopharmacologist who is not connected with the case, said the Clancy trial has been “an opportunity to remind us all about the complexities of severe mental illness and the complexities of treating mental illness.” He said finding the right medicine is less trial and error than “successive efforts to home in on the target.” Goldberg, a professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York, said, “Based on my assessment of what the adversary looks like – the adversary being the depression or the psychosis or the panic attacks or the anorexia, or whatever we pick from the 250-some-odd diagnoses that we have – then I try to conform my arsenal to your unique presentation.” He also said, “Every person has their own individual presentation. Just like my flu is not the same as your flu, my depression is not the same as hers.”
Dr. Ripal Shah, a psychiatrist and clinical associate professor of psychiatry and behavioral sciences who practices at Stanford Health Care and specializes in women’s reproductive psychiatry, said there’s a lot of subjectivity in psychiatric diagnosis and treatment. “There’s a lot of subjectivity to it on both sides, on the patient and provider side,” Shah said. “We do understand brain changes and are able to do imaging testing and lab testing once that illness has been found,” she said. Shah said psychiatrists need to be good detectives during the entire process and that determining whether a medication is working relies on the person’s subjective experience. “If someone has cloudy perception due to depression or disorganized thoughts, it can be difficult for a patient to come forward with an organized understanding of how they are doing on the medication,” Shah said.
The article says nearly a third of adults with major depressive disorder fail to respond to at least two antidepressants, and half of people treated for generalized anxiety disorder do not respond to first-line treatments, studies show. A growing number of psychiatrists are trying brain imaging or pharmacogenetic testing to better match patients to medications. Pharmacogenetic testing, done with a cheek swab, blood draw or saliva sample, analyzes how someone’s genes affect their body’s response to certain medicines, including how quickly it absorbs the drug or whether they may have serious side effects. The test does not tell a doctor whether one medicine or another will be the perfect fit, but it can help with treatment choices if two medications are otherwise considered equal.
Goldberg said, “The idea of bespoke medicine and personalized medicine is great. And we’re getting closer.” That’s the pitch: better targeting, fewer failures, less suffering. But the article’s own facts keep dragging the reader back to the same hard reality — a system built on categories, compliance, and expert authority still leaves too many people cycling through medications, side effects, and uncertainty while the people making the decisions stay insulated from the wreckage.
The piece ends with an editor’s note saying help is available if readers or someone they know is struggling with suicidal thoughts or mental health matters. In the U.S., it says, call or text 988 for help. It also lists the International Association for Suicide Prevention and Befrienders Worldwide as sources of contact information for crisis centers around the world.