The Journal. — Episode Summary

Episode Title: For Many Kids on ADHD Pills, It’s the Start of a Drug Cascade
Podcast: The Journal.
Hosts: Ryan Knutson & Jessica Mendoza
Date: January 23, 2026
Produced by: Spotify & The Wall Street Journal

Overview

This episode investigates how children diagnosed with ADHD and treated with stimulant medications often end up taking a series (“cascade”) of psychiatric drugs over their lifetime. Through personal testimony and new reporting, the hosts and their guests discuss the lack of research on polypharmacy in children, the medical and societal forces that drive overprescribing, and the long-term consequences for children and families.

Key Discussion Points & Insights

1. Personal Story: Danielle and Nancy Gansky

• Danielle was diagnosed with ADHD at 7 and promptly prescribed stimulants like Ritalin and Adderall.
• Over the years, her medication list expanded to include antidepressants (Prozac), anti-anxiety drugs, and even antipsychotics.
• Both Danielle and her mother, Nancy, describe feeling overwhelmed, confused, and reliant on doctors' recommendations.
• Danielle reflects on the impact: “Basically my whole life I was chemically altered and every drug induced effect that made me feel terrible was blamed on the so-called worsening of my underlying disorder.” — Danielle (08:24)

Memorable Mother-Daughter Moments

• Nancy recounts heartbreak over her daughter's long list of medications:

  "It's just, you hear it and it's like she was a child 7, 8, 9, 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." — Nancy (02:58)

2. Wall Street Journal Investigation & Data

• The WSJ analyzed Medicaid data from 2019–2023 for 166,000 kids on ADHD meds versus those not medicated.
• Findings:

  “The children prescribed ADHD medication were more than five times as likely to be on additional psychiatric drugs four years later.” — Shalini Ramachandran, reporter (06:20)

• This correlation held even after accounting for sex, race, and foster care status.
• Although correlation was strong, causation wasn't proved.

3. Side Effects and Drug Cascade

• Danielle describes the stimulant “crash” after school:

  “You would take the drug… it would give you kind of like a high… but then at the end of the day, I would have a crash from it coming off, and that would make me just a monster, really moody and agitated.” — Danielle (07:14)

• Symptoms led doctors to prescribe further medications, each of which brought new side effects and further prescriptions:

  “Every answer is a pill, let’s change it, let’s go up or up the dose, up the dose.” — Nancy (08:07)

• Danielle’s psychiatric medication list kept being added to, rarely subtracted from.

4. Medical Practice Realities

• Doctors rarely flagged the growing number of Danielle’s prescriptions.
• Psychiatric prescribing for children is often “trial and error,” according to reporter Shalini Ramachandran (09:27).
• Parents are left feeling the system is authoritative but, in reality, it is improvisational and sometimes overwhelmed.

5. Lack of Research on Polypharmacy

• There is little scientific research on the effects of multiple psychiatric drugs on developing brains.

  “Really, when there’s children on multiple psychiatric medications… if you think about preschoolers, one psychiatrist told me, they’re loose cannons in how they react to these medications.” — Shalini (10:13)

• Doctors continue to prescribe despite not knowing long-term risks.

6. Getting Off Medications: Withdrawal and Difficulty

• Danielle’s attempts to stop drugs were traumatic; antidepressant withdrawal caused severe symptoms (pain, shaking, vision loss).
• Doctor misattributed withdrawal to underlying disorder and prescribed Zyprexa (antipsychotic), which caused frightening side effects:

  “It was as if my mind had been stolen from me. It felt like a chemical lobotomy.” — Danielle (15:37)

• Tapering off drugs is a painfully slow, years-long process for Danielle, with the help of a specialist and compounded bespoke medications (19:24–19:37).

7. Doctors vs. Non-Medication Therapies

• For children six and under, behavioral therapies like Parent-Child Interaction Therapy are recommended first.
• These therapies are difficult to access and require significant parental effort and commitment:

  “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?” — Shalini, paraphrasing parents (17:08)

• 42% of children aged 3–5 are prescribed medication within 30 days of ADHD diagnosis. (Stanford study, 18:01)
• Doctors often feel pressured by parents and schools to provide immediate solutions, leading to quick prescriptions (18:26).

8. Reflections, Regrets, and Mixed Outcomes

• Nancy expresses deep regret:

  “If I had a time machine, I would probably not medicate my daughter… I would do things much differently.” — Nancy (20:27–20:43)

• Some parents appreciate the benefits of ADHD medications, and clinical trials confirm that they are safe and effective for many (21:13–21:42).
• But for some, “I don’t know who I was before medication” is an enduring cost (21:32–21:42).

Notable Quotes & Timestamps

• “[ADHD meds] were just the highlights for this call, but I think it's a little longer.” — Danielle (01:43)
• “Basically my whole life I was chemically altered and every drug induced effect that made me feel terrible was blamed on the so-called worsening of my underlying disorder.” — Danielle (08:24)
• “Psychiatrists would just openly say, I mean, it's trial and error. Give them one thing, see how they do with it...” — Shalini Ramachandran (09:27)
• “There's very little, very little research on what cocktails and drugs do for a child's brain.” — Shalini Ramachandran (10:13)
• “It felt like a chemical lobotomy.” — Danielle (15:37)
• “That pace is very, very slow. Danielle is working with a compound pharmacy... and is reducing her medication by one tenth of a milligram at a time.” — Host (19:24)
• “I probably, knowing what I know now about the harms of these medications, I would not medicate her. I would do things much differently.” — Nancy (20:32)

Important Segment Timestamps

• 00:08–03:19 — Danielle & Nancy introduce their story, detailing childhood diagnosis and start of medication
• 05:24–06:20 — Wall Street Journal data & investigation findings
• 07:14–08:24 — Danielle and Nancy describe the onset of medication side effects and polypharmacy
• 09:27–12:11 — Shalini Ramachandran explains doctors’ prescribing logic and trial-and-error approach
• 14:19–15:37 — Danielle and Nancy recount attempts to quit medications and withdrawal symptoms
• 17:00–18:01 — Behavioral therapy barriers and overreliance on medication for young kids
• 19:14–19:53 — Danielle’s slow, difficult tapering process
• 20:27–20:43 — Nancy’s regret and what she would have done differently
• 21:13–21:42 — Balanced view: Some children benefit greatly from medication, but others face lasting consequences

Conclusion & Takeaways

This episode offers a compelling look at the unintended, often lifelong consequences some children face after being medicated for ADHD. While medications can be effective, the ease of “prescription stacking,” the lack of research into long-term polypharmacy effects, and the enormous difficulty of withdrawal all paint a cautionary tale. Parents, doctors, and policymakers are urged to be more critical, seek systemic change, and pursue gentler, less invasive therapies where possible.

This summary captures the main themes, investigative findings, and emotional testimony presented in the episode.