Massachusetts mom Lindsay Clancy, who faces murder charges for allegedly killing her three kids, is in a “flat” emotional state as a result of a cocktail of prescription medications and the depression that she’s experiencing in the wake of her botched murder-suicide, a psychologist said.

Dr. Paul Zeizel, a psychologist hired by Clancy’s lawyer to evaluate her, told the Daily Mail that the 32-year-old woman is “extremely fatigued” and “in pain” as she lies in a hospital after suffering debilitating spinal cord injuries.

“She is flat as a board — she’s wondering what is going on,” Zeizel told the news outlet. “There is not a lot of emoting, though she did shed tears yesterday during the court hearing.”

He said her “flat” demeanor could be caused by a combination of pain and psychotic meds, in addition to her depression.

Clancy, who was on leave from her job as a labor and delivery nurse at Massachusetts General Hospital, has been hospitalized since she jumped out a window in the grisly attempted murder-suicide at her Duxbury home on Jan. 24.

She claimed that she heard a man’s voice telling her to kill her children before she strangled them with exercise ropes, prosecutors said at her arraignment Tuesday.

Clancy’s attorney, Kevin Reddington, alleged that she was a victim of a health care system that fails women with “postpartum depression – and even postpartum psychosis.” 

Zeizel told the Daily Mail that it remains a “conundrum” how she ended up being on more than a dozen prescription drugs, including Prozac and Seroquel, which her lawyer said can cause homicidal ideation as a side effect

“This is nightmarish, it is so sad. And to think the job she had was the very environment in which she was suffering … it is a tragedy,” Zeizel told the outlet.

He said people experiencing psychosis or schizophrenia may hear voices in their heads.

“These voices, they can come and go. They are unpredictable,” Zeizel said, adding that it was entirely possible that Clancy had been behaving “normally,” as the prosecution claims she had, before her kids’ deaths.

The psychologist, who has not formally diagnosed the woman, noted that she knows who she is and who her children were.

The male voice Clancy claimed told her to kill Cora, 5, Dawson, 3, and Callan, 8 months, is an example of “command hallucinations,” a sign of psychosis, according to experts.

They are “telling you to do things, telling you things that are malevolent, and you believe those voices,” Zeizel told reporters Tuesday, according to the Boston Globe.

He said people with severe mental illness can still “present as being lucid and linear and clear-thinking.”

Dr. Liza H. Gold, a clinical professor of psychiatry at Georgetown University, told the Globe that “the fact that you’re psychotic doesn’t mean you’re suddenly incapable of any rational thought altogether.”

Gold, who is not involved in the case, added: “When you see there is a murder-suicide going on, that’s usually profound psychosis, and it’s not unusual to find a command hallucination.”

“You hear a voice telling you to do something. It repeats over and over. ‘You’re a terrible mother. Your children are going to hell unless you kill them now,’ ” she said.  

“If you’re acting at the behest of a command hallucination, how much agency do you really have?” Gold added.

Clancy had slit her throat and wrists before leaping out her window while her husband, Patrick, was out running errands, including getting takeout.

Dr. Jeffrey S Janofsky, director of the Psychiatry and Law Program at Johns Hopkins Medicine, said “planning can happen along with delusions. The mere fact that they planned it does not exclude an insanity plea.”

Janofsky added that command hallucinations are merely a symptom and not a legal defense.

“You have to figure out what the illness is,” he told the Globe.

The mom had also been taking benzodiazepines, which treat anxiety and insomnia.

“It is possible that withdrawal from chronic benzodiazepine use could cause psychotic symptoms, including auditory hallucinations,” Janofsky said.

Assistant District Attorney Jennifer Sprague said Clancy had asked whether she needed a lawyer on Jan. 27, the day Callan died, showing that she had “the clarity, focus, and mental acumen to focus on protecting her own rights and interests.”

But experts said she could still have been suffering from delusions at the same time.

Her lawyer has not explicitly said he plans to mount a defense of not guilty by reason of insanity.

“To plead not guilty by reason of insanity is a Hail Mary,” Gold told the paper. “Those cases have a very limited success rate. … When it goes against the gender stereotypes, it’s even more difficult.”

Clancy was charged with two counts of murder and three counts of suffocation or strangulation, with the charges expected to be upgraded to account for her youngest child’s death.