Lindsay Clancy sat silently at her arraignment at Tewksbury Hospital on Thursday while a court official read off the murder and strangulation charges she faces.

Across the table sat a Plymouth County prosecutor who would recount the events of Jan. 24, when authorities found her three children strangled by exercise bands and Clancy bloodied and lying on the ground outside their Duxbury home in an apparent suicide attempt.

Clancy, dressed in black and wearing a blue surgical mask, said “not guilty” softly when asked how she responded to three counts each of murder and strangulation in the deaths of her children 5-year-old Cora Clancy, 3-year-old Dawson Clancy, and 8-month-old Callan Clancy.

The court proceeding took place at the hospital as Clancy remains under psychiatric care and her defense attorney said she is “permanently paralyzed” as a result of jumping out of the second-story window.

Several new details emerged during the Plymouth Superior Court arraignment on Thursday, including details about the medications Clancy was prescribed, what happened on Jan. 24, and what is next for the Duxbury mother.

• Read more: Lindsay Clancy wrote ‘I sort of resent our children’ months before their killing

Medications for postpartum depression at center of arguments

Notes taken in journals and her cell phone show that Clancy, 33, took detailed accounts of her life, her children’s lives and the medication she was prescribed for postpartum depression and anxiety in the months leading up to the children’s killings, according to Sprague.

“Her writing was clear and precise and articulate,” Sprague said. “There’s no disordered thoughts or speech. No mention of hallucination or any delusions.”

Clancy wrote the day before the children’s deaths that she had a “touch of postpartum anxiety” around returning to work, Sprague said.

On the day of the children’s deaths, Clancy asked her husband to pick up medicine for the children and get takeout from a restaurant in Plymouth before he returned home and found three unconscious children with “obvious signs of trauma” and attempted suicide by his wife, Sprague said at Clancy’s initial court appearance in February.

Defense attorney Kevin Reddington contends Clancy was overmedicated and that she suffered from postpartum psychosis or postpartum depression.

• Read more: How friends described a Mass. mother days before police say she killed her kids

Blood samples drawn

A psychiatrist retained by the Plymouth District Attorney’s Office reviewed Clancy’s medical records, prescription history and her journals and she “didn’t find anything out of the ordinary in the manner of treatment or the medications that were prescribed by her providers,” according to Sprague.

The doctor also reviewed toxicology reports of blood samples taken from Clancy on Jan. 24 at 8:18 p.m., only a couple hours after the children were found dead.

Seven different medications were found in Clancy’s results, a mix of anti-depressants and sedatives, and all were found to be at a “therapeutic” level except for Seroquel, an anti-psychotic, which was found at a toxic level, according to Sprague.

Some of the medications found in her blood were at “peak levels,” which meant that she had taken them about two hours before the tests.

“This would mean that the defendant took this large amount of Remeron (an antidepressant) and Seroquel after she killed her children,” Sprague said.

Clancy spoke with her husband on the phone at 5:35 p.m. and a fitness app showed that she climbed the stairs in the home after the call. By 6:09 p.m., Clancy’s husband arrived home to find her wife on the ground, according to the prosecutor.

Sprague added that one of the drugs found in the highest quantity in Clancy’s blood was for anti-psychosis in arguing that Clancy was in a clear frame of mind.

Reddington described Clancy as a “marvelous, incredible mother” and that she “obviously had no reason to kill those three beautiful children.”

“You have to ask yourself why. Why? And when you ask yourself why, you consider all these factors, it’s readily apparent that this woman was a troubled soul,” he said.

Reddingon also said getting Clancy’s medical records have been difficult to obtain and that the Duxbury mother only had one appointment where medical providers determined she did not have postpartum depression.

“It’s a joke,” he said.

Parents of both Clancy and her husband stayed with the family at times in their Duxbury home because she was “unable to function” due to her mental state, Reddington said.

• Read more: Timeline of Duxbury killings: Prosecutor lays out case against Lindsay Clancy

Prosecutor on self-inflicted wounds

When Clancy’s husband, Patrick, arrived home, he was the first to discover the children strangled, a horrifying scene recorded by a 911 call.

He also found a bloodied knife in their bedroom that Sprague described on Thursday as used to “inflict superficial cuts and scratches through her wrists and neck.”

Sprague gave a more detailed account of what investigators found that night.

There were blood stains on the outside of the window sill where she grabbed onto before slidding down the siding of the house, she said.

“She did not jump,” Sprague said. “She did not hurl herself because there’s blood on the exterior shingle going down.”

Reddington pushed back on the claims of superficial cuts, saying when he visited the house, there were “copious” amounts of blood at the scene and that they were not small scratches on her wrists.

As for jumping out of the window, Reddington said, “She obviously hit the ground transecting the spine … She’s not going to be fine. She’s permanently paralyzed.”

• Read more: ‘She killed the kids’: Documents detail horrifying scene at Duxbury home

What’s next for the Duxbury mother

On Thursday, Plymouth County Judge William Sullivan ordered her to remain held at the hospital after finding her at a “serious risk of imminent self-harm.” Plymouth County prosecutors and her defense attorney did not object to the judge’s order.

The arraignment took place over Zoom and a court clinician interviewed Clancy prior to the hearing and the clinician said that Clancy had “little to no emotional expression” and that Clancy expressed “on going daily thoughts of suicide.”

The clinician recommended Clancy’s further hospitalization and noted that Tewksbury Hospital would accept the Duxbury mother for a period not to exceed six months.

Through court documents and the arraignment this week, it was revealed that Clancy used her cell phone to look up “Can you treat a sociopath?” and “ways to kill” in the days leading up to the killings.

• Read more: Here’s what investigators found inside Mass. mother’s home after deaths of 3 children

Reddington, however, said that he believes Clancy has a good defense and a “very strong case” should it go to trial.

An online donation drive to support Patrick Clancy surpassed $1 million. In a message posted there, Patrick Clancy asked people to “find it deep within yourselves to forgive Lindsay, as I have.”

“The real Lindsay was generously loving and caring towards everyone – me, our kids, family, friends, and her patients,” he wrote. “The very fibers of her soul are loving. All I wish for her now is that she can somehow find peace.”

Clancy’s case is continued in Plymouth Superior Court until December 15.