For Many Kids on ADHD Pills, It’s the Start of a Drug Cascade

0:05Do you want to just start by introducing yourselves? My name is Danielle Gansky. I'm 29 years old. My name is Nancy Gansky, and I am Danielle's mother. You can do the math on my age. A little over 20 years ago, Nancy got a phone call about her daughter, Danielle, that many parents might be familiar with. The head of the lower school called me in and wanted to talk to me about Danielle and getting her tested, maybe for some ADHD or ADD or some learning issues because Dani was not sitting still in class and they weren't sure if the school was quite the fit for her anymore. And I remember coming home and telling my husband and just crying and saying, what is happening?

0:51It was just really confusing and mind-boggling, to tell you the truth. Was ADHD something that was on your radar at that point? Never. I didn't even—that was the first time I heard of it. Danielle was diagnosed with ADHD at seven years old and started taking a stimulant. She tried out different ones, like Ritalin and Adderall. On their own, ADHD medications like these have been shown to be safe and effective in clinical trials. And many say taking the drugs has made a huge difference. But for Danielle, what began with ADHD started her down a cascade of medications. Soon, she was taking a daily cocktail of powerful pills.

1:32So this document is my list of psychiatric medications that I've been on over my whole lifetime. It's two pages. It looks like a long list. Actually, I think that's whittled down. There's actually more. That was just the highlights for this call, but I think it's a little longer. So at age 7, so it's Prozac, Ritalin, Datrona, Concerta, Adderall. And then ages 8 to 10, we have Prozac, Concerta, Adderall. ages 11, Prozac, Welbutrin, Intuniv, Concerta. So age 12, Prozac, Concerta. 2009, Prozac. The list goes on. And over time, Danielle went from taking ADHD medications to also taking antidepressants like Prozac and then anti-anxiety drugs like lorazepam and Xanax.

2:29Danielle is not alone. A Wall Street Journal investigation found that a portion of kids that start on ADHD medication at a young age are more likely to wind up taking additional psychiatric drugs, which, as Danielle and her mother discovered, can have serious side effects and be very difficult to get off of.

2:53Nancy, what do you feel when you hear Danielle's list of medications? It's just, you hear it, and it's like, she was a child. seven, eight, nine, 10 years old to be put on pharmaceuticals like this. I mean, I wish I could go back in time, but it just breaks my heart that she had to go through this. And it's hard to listen to. It's hard to see, to be honest with you.

3:19Welcome to The Journal, our show about money, business, and power. I'm Ryan Knutson. It's Friday, January 23rd.

3:33Coming up on the show, how an ADHD diagnosis can kick off a lifetime of psychiatric prescriptions.

3:49This episode of The Journal is presented by Intuit Enterprise Suite. If your finance team spends more time finding data than using it, If there's one entity here and one here and one here and one here, if scaling your business feels like starting over, you need the Intuit ERP. Intuit Enterprise Suite. The AI native ERP is here. From the makers of QuickBooks. Learn more at Intuit.com slash ERP. Brought to you by Apple Card. Hey, you could be earning 2 % daily cash back on that purchase. And that one. And even that one. That's because Apple Card users earn 2 % daily cash back on every purchase, including everyday items you buy online or in-store, when using their Apple Card with Apple Pay.

4:35Not an Apple Card customer? You can apply in the Wallet app on iPhone. Subject to credit approval. Apple Card issued by Goldman Sachs Bank USA Salt Lake City Branch. Terms and more at apple.co slash benefits.

4:52Over the past year, our colleague Shalini Ramachandran and a team of reporters have been working on a series of stories about over-medication in the U.S. and the unintended consequences of taking medications for anxiety, pain, and depression. We've been covering some of this reporting on our show. There are some links in our show notes. Here's Shalini. We heard from readers as we were doing the series, we heard people writing in, you know, as a child, I was prescribed Adderall or Ritalin and ended up sort of completely in what's called polypharmacy with a number of psych meds. That's what sort of got us down this path of wanting to look at this question.

5:32The journal analyzed Medicaid data from 2019 through 2023 for 166 ,000 kids taking ADHD medications and compared them against kids who didn't take ADHD medications. And what they found was striking. The children prescribed ADHD medication were more than five times as likely to be on additional psychiatric drugs four years later. And, you know, differences in sex and race and foster care status didn't explain the gap. This polypharmacy problem is more pronounced when the children start very young on these ADHD meds. To be clear, the Wall Street Journal's analysis didn't determine whether or not the ADHD medication caused the Cascade to More Meds, only that there was a correlation between the two.

6:19And this is something that Danielle experienced firsthand. I often say to myself, I wonder what my life would have been like and how my brain would have developed had I not been medicated.

6:34After Danielle, seven years old, was put on a stimulant to treat her ADHD, she started experiencing common side effects. I remember actually coming home from school and just being a complete monster because, you know, you would take the drug, the Adderall in the morning and, you know, it would give you kind of like a high in a sense. It would make you chatty and all these things. But then at the end of the day, I would have a crash from it coming off of it and that would make me just a monster, really moody and agitated. it. And I think that you remember that. I do remember.

7:13It was those side effects that Danielle and her mother say led to a cascade of prescriptions. And then at one point they put her on Prozac saying, oh, she has a mood issue now.

7:26Prozac is an antidepressant and it was the first drug Danielle started taking that wasn't an ADHD medication. But it just seemed to create new side effects. And I would tell the doctor, oh, she's doing this, or I see this action, or her anxiety's increased. But every time I said something, well, let's go up on this. Let's change this. Let's try this. Every answer is a pill. Let's change it. Let's go up. Or up the dose. Up the dose. Basically, my whole life, I was chemically altered. And every drug-induced effect that made me feel terrible was blamed on this so-called worsening of my underlying disorder.

8:05Do you remember, Nancy, when like the first time that it started to go from just Ritalin ADHD to a second drug? And did you, what did you think? I just listened to them. What I'm being told by a doctor who was a psychopharmacologist, he knew best, right? That's what I thought that, nope, this is her, this medicine will help her. and I listened to him. So I just listened to what the doctors said and said, okay, anything I could do to get Dani in a better place and feel better, I thought this was going to help, right? Because she, does she have a mood issue? You know, she's cranky at the end of the day.

8:44Okay, let's take a pill and fix it. Danielle went to multiple doctors over the years. She says none of them raised a red flag about the amount of medications she'd been taking. Here's our colleague Shalini again. You kind of think as a parent, like all these doctors, they probably have got it all figured out. They know like what dose to give. They know what type of medication to give if you have a problem. That's not the case. You know, psychiatrists would just openly say, I mean, it's trial and error. You know, give them one thing, see how they do with it. If they're super lethargic or, you know, really over, if there's all kinds of bad symptoms, try something else, try a different dose.

9:23And parents are often left, you know, really struggling in these early years trying to manage that.

9:32What kind of research is there about the cocktail of drugs that kids start to take and what impact this may have on their developing brains? There's very little, very little research on what cocktails and drugs do for a child's brain. So really, when there's children on multiple psychiatric medications, and especially when you're giving these heavy-duty medications to young children, if you think about preschoolers, one psychiatrist told me, they're loose cannons in how they react to these medications. It's really kind of astonishing to me that the medical community and really any clinician could say, well, there's not much research on how this cocktail of drugs is going to affect a nine-year-old and their developing brain, but I'm going to give it to them anyway, you know?

10:27I think from a doctor's point of view, they feel that pressure to prescribe, of course, that parents want an answer when they come in. But they also say that just because it's not like something that's in a scientific study, maybe in their clinical practice, they observed that adding on an antidepressant for some certain cases helped. Do doctors think that they're treating side effects from drugs? Like, do doctors think, oh, we put them on this drug and it has a side effect, so we should treat that side effect with a drug? or do they often think, well, no, it's actually, there's a new problem that has started that needs a drug separately?

11:09I think that's sometimes hard to figure out for the doctors. They can only know what they see in that small 15-minute appointment with you. They're not with you all the time. They're not sure if the patient is really having a bad reaction to the medication or if they're just having a new episode of whatever it is that they originally diagnosed. Like, if it's depression, are they just more depressed right now and actually need a higher dose?

11:39Danielle says that all these drugs took a toll on her. I felt agitated. I felt moody. You know, there's times when I would feel like a zombie, like really out of it. I think that was more in my teenage years when I would be on like three drugs at the same time. whether that was like Prozac or an antipsychotic or like a benzo, just too many things going on. And I think it was too much for my nervous system, you know, being pulled off one drug, put on another. It was just agitating me. Do you feel like the drugs helped with anything along the way? I mean, were you able to focus better in class? So when I look back, like at that young, just if I was focusing better in class, I can't fully recall that specifically.

12:34I mean, perhaps in the way they make you like laser focus, but in such an artificial, unnatural way, you know, but I don't. I think they had so many more adverse effects that it was just not. It was never worth it.

12:54Coming up, what happened to Danielle when she tried to get off the medications?

13:05If you've been diagnosed with moderate to severe plaque psoriasis, this is what it sounds like to be a million miles away. Imagine being a million miles away.

13:23Trimphaya Cuselcumab Taken by injection is a prescription medicine for adults with moderate to severe plaque psoriasis who may benefit from taking injections or pills or phototherapy With Trimphaya, clearer skin is possible In clinical trials, at least 70 % of patients saw at least 90 % clearer skin at 16 weeks Results may vary. Trimphaya is also indicated for adults with active psoriatic arthritis. Serious allergic reactions and increased risk of infections and liver problems may occur. Before treatment, your doctor should check you for infections and tuberculosis. Tell your doctor if you have an infection, flu-like symptoms, or if you need a vaccine.

13:59Tap this ad to learn more about Trimphia, including important safety information. This episode is brought to you by Indeed. The right hire can make or break your company, especially if you're a small business. And relying on luck to find that person isn't really the best strategy. But you know what is? Using Indeed Sponsored Jobs. You can use it to boost your job post to make sure it reaches more people with the right talents, certification, location, and more. Sponsored jobs posted directly on Indeed are 95 % more likely to report a hire than non-sponsored jobs. Spend less time searching and more time actually interviewing candidates who check all your boxes.

14:36Less stress, less time, more results. When you need the right person to cut through the chaos, this is a job for Indeed Sponsored Jobs. And listeners of this show will get a$75 sponsored job credit to help get your job the premium status it deserves at Indeed.com slash podcast. Just go to Indeed.com slash podcast right now and support the show by saying you heard about Indeed here. Indeed.com slash podcast. Terms and conditions apply. Hiring now? Then this is a job for Indeed sponsored jobs.

15:09as danielle got older she started telling her mom she wanted to stop taking all these drugs i remember one time we went to the doctor and she said i really want to come off i don't feel well and he would convince both of us that she needed this we're like okay and then halfway home i remember pulling over one time she was like i can't believe he doesn't listen to me she was really upset. And I wish I would have listened to her. I'm like, no, no, Danny, you need this. I was full on behind the doc, right? I didn't, I was like, he's a doctor. And she would get really, really upset. Eventually, Danielle made up her mind.

15:45After college is when I decided it would finally be time. And I wanted to see really who I was underneath the chemicals that had I've been hijacking my brain for so many years.

15:59With help from doctors, Danielle began to wean off the cocktail of drugs she'd been taking nearly her entire life. She says the antidepressants turned out to be the most difficult thing to get off of. Danielle made multiple attempts, and it was excruciating each time. She went through intense withdrawals that included symptoms like pain, uncontrollable shaking, sensitivity to light and sound, and vision loss. Once, her doctor told her those withdrawal symptoms were due to an underlying mood disorder, and they prescribed her another pill. I was given a heavy-hitting antipsychotic called Zyprexa, and after that first dose, something very terrifying happened.

16:44I couldn't think. I couldn't speak. I felt trapped inside my own body almost like locked-in syndrome. It was as if my mind had been stolen from me. It felt like a chemical lobotomy.

17:03It's extremely difficult for people who get on this cocktail of drugs to get off of drugs. I'll call like Shalini again. Each of these psychiatric medications are affecting your nervous system, and they often can take months, sometimes years, to wean off of. When these prescriptions start being layered on, what is understood about how difficult it will be to stop these drugs in the future? There's definitely scientific research that it's pretty difficult to stop, get off, for instance, benzodiazepines, antidepressants, and some people, you can develop physical dependencies to drugs that make it really difficult to stop.

17:44And I think when you layer things on, that's when there's actually little study and research about what a layered cocktail, how hard it is to get off of something like that.

17:56For children who get diagnosed with ADHD, is there anything else that can be done other than medication? so for children six and under it's recommended that you first try really effective behavioral therapy called parent-child interaction therapy problem is it's really hard to get those we talked to many parents were like we took a whole day off work we tried calling around we couldn't find anybody who could give us therapy what choice did we have we were under pressure from our preschool or from the teachers and kids acting out. And also doing them is really labor-intensive for a parent. It could take six, nine months of intensive work to work through some of these common symptoms of ADHD, like defiance and aggression and things that, the type of things you might get phone calls home from your preschool teachers about.

18:51And so you end up medicating young children very early. According to a Stanford University study, more than 42 % of children age 3 to 5 are prescribed medication within 30 days of an ADHD diagnosis. Meaning doctors may be directing parents to drugs before giving behavioral therapy a chance to work. How many doctors and prescribers did you talk to and what did they say when you told them about this issue of layering different psychiatric prescriptions? We talked to dozens of clinicians and many, many more also wrote in. Many psychiatrists and pediatricians said, oh my gosh, I've seen these kinds of cases before.

19:36This has absolutely happened, this happening. And many talked about sort of the pressure to prescribe that sometimes they feel because parents come in wanting an answer, a quick answer. Not one that's going to take months and months and months of therapy, but a quick answer to problems that they're facing every day at school, like getting phone calls home, things like that.

19:59Today, Danielle doesn't take medication for ADHD anymore, but she still takes an antidepressant. She says she still experiences symptoms like brain fog and cognitive dysfunction. I'm very lucky to have eventually found a psychiatrist who I work with now who understands and is helping me taper off at the pace my body can tolerate. That pace is very, very slow. Danielle is working with a compound pharmacy to give her a customized dose and is reducing her medication by one-tenth of a milligram at a time. That's less than 1 % because that's all my nervous system can tolerate. And even then, I often need months just to stabilize before attempting another reduction.

20:44How long do you think this taper could take? You know, I think about that a lot. And something that scares me is that I may never be able to come off. but I know for some people tapers can last years and years and years and it's, you know I don't know because my brain developed on these drugs I don't know if I'm going to be able to come off

21:17Nancy if you had a time machine what would you do differently? If I had a time machine I would probably not medicate my daughter At all? No, I would, I probably, knowing what I know now about the harms of these medications, I would not medicate her. I would do things much differently. We've talked to other families who've gone through similar journeys where the parents were like, well, I thought that's what we had to do at the time with the fact that our teacher was saying this, or the daycare provider was threatening to kick them out. and you know many of them say I wish I knew what they were like without medications had I not chosen that path.