C (2:58)

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. And it's hard to listen to. It's hard to see, to be honest with you.

A (3:19)

Welcome to the Journal, our show about money, business and power. I'm Ryan knudsen. It's Friday, January 23rd. Coming up on the show, how an ADHD diagnosis can kick off a lifetime of psychiatric prescriptions.

D (3:49)

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E (4:20)

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A (5:24)

Over the past year, our colleague Shalini Ramachandran and a team of reporters have been working on a series of stories about overmedication in the US 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.

F (5:43)

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.

A (6:04)

The 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.

F (6:20)

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.

A (6:40)

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. And this is something that Danielle experienced firsthand.

B (6:54)

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 medic.

A (7:06)

After Danielle, at seven years old, was put on a stimulant to treat her adhd, she started experiencing common side effects.

B (7:14)

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. And I think that you remember that.

C (7:40)

I do remember.

A (7:44)

It was those side effects that Danielle and her mother say led to a cascade of prescriptions.

C (7:50)

And then at one point they put her on Prozac, saying, oh, she has a mood issue now.

A (7:57)

Prozac 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.

C (8:07)

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.

B (8:24)

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.

A (8:36)

Do 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?

C (8:46)

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 can 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, okay, let's take a pill and fix it.

A (9:18)

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.

F (9:27)

You kind of think as a parent, like everybody, all these doctors, they probably got it all figured out. They know what dose to give, they know what type of medication to give if you have a problem. That's not the case. Psychiatrists would just openly say, I mean, it's trial and error. Give them one thing, see how they do with it. If they're super lethargic or really over, if there's all kinds of bad symptoms, try something else, try a different dose. And. And parents are often left, you know, really struggling in these early years trying to manage that.

A (10:04)

What 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?

F (10:13)

There's very little, very little research on what cocktails and drugs do for a child's brain. So really, when you're, when there's children on multiple psychiatric medications, and especially when you're giving these heavy duty medications to young children, you know, if you think about preschoolers, one psychiatrist told me, they're loose cannons in how they react to these medications.

A (10:40)

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 gonna give it to them anyway. You know.

F (10:59)

I think from the doctor's point of view, they sort of, they feel that pressure to prescribe, of course, that, you know, 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.

A (11:24)

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?

F (11:41)

I 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?

A (12:11)

Danielle says that all these drugs took a toll on her.

B (12:15)

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.

A (12:50)

Do you feel like the drugs helped with anything along the way? I mean, were you able to focus better in class?

B (12:57)

So when I look back, like at that young, just if I was focusing better in class, I can't fully recall that specifically. I 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 would just not. Was never worth it.

A (13:26)

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

G (13:37)

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A (14:13)

As Danielle got older, she started telling her mom she wanted to stop taking all these drugs.

C (14:19)

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 dock, right? I didn't, I was like, he's a doctor, right? And she would get really, really upset.

A (14:45)

Eventually, Danielle made up her mind.

B (14:48)

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

A (15:03)

With help from doctors, Danielle began to wean off the cocktail of drug 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.

B (15:37)

I was given a heavy hitting antipsychotic called Zyprexa. And after that first dose, something very terrifying happened. I 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.

F (16:07)

It's extremely difficult for people who get on this cocktail of drugs to get off of drugs.

A (16:13)

Our colleague Shalini Again, each of these.

F (16:16)

Psychiatric medications are affecting your nervous system and they often take, can take months, sometimes years to wean off of.

A (16:25)

When these prescriptions start getting layered on, what is understood about how difficult it will be to stop these drugs in.

F (16:32)

The future, there's definitely scientific research that it's pretty difficult to stop. Get off, for instance, benzodiazepines, antidepressants, and, you know, some people we can develop physical dependencies to drugs that make it really difficult to stop. And 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.

A (17:00)

For children who get diagnosed with adhd, is there anything else that can be done other than medication?

F (17:08)

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 as many parents who were like, we, 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. And so you end up medicating young children very early.

A (18:01)

According to a Stanford University study, more than 42% of children aged three to five 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?

F (18:26)

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. This 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. 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.

A (19:03)

Today, 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.

B (19:14)

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.

A (19:24)

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.

B (19:37)

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.

A (19:48)

How long do you think this taper could take?

B (19:53)

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. 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.

A (20:21)

Nancy, if you had a time machine, what would you do differently?

C (20:27)

If I had a time machine, I would probably not medicate my daughter.

A (20:30)

At all?

C (20:32)

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.

F (20:43)

We've talked to other families who've gone through similar journeys where the parents felt 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 then there. I have to also say that there are many parents who are happy with how ADHD medications have helped their children, and clinical trials show that ADHD drugs are safe and effective for many children. But I think what we've seen is that for a portion of children, their lives end up on the path like Danielle's, where additional medications get layered on to the point where they themselves and their parents say, like, I don't know who I was before medication.

A (21:42)

That's all for today. Friday, january 23 the journal is a co production of Spotify and the wall street journal. Additional reporting in this episode by betsy mckay, tom mcginty and audrey valbuena. Special thanks to andrew stelzer. The show's made by catherine brewer, victoria dominguez, pia gadkari, isabella japal, sophie codner, matt kwong, colin mcnulty, jessica mendoza, annie minoff, laura morris, enrique perez de la rosa, sarah platt, alan rodriguez espinosa, heather rogers, piers singhy, jeevika verma, lisa wang, katherine whalen, tatiana zamis and me, ryan knudsen. Our engineers are griffin tanner, nathan singapak and peter leonard. Our theme music is by so wiley. Additional music this week from katherine anderson, marcus bagala, peter leonard, emma munger, nathan singapok and blue dot sessions. Fact checking this week by mary mathis. Thanks for listening. See you on Monday.