Elon Musk is not a doctor. He is not a psychiatrist or any other type of mental health professional. But on Friday, he expressed a very strong opinion about Wellbutrin, an antidepressant drug, on Twitter. Yes, Twitter, that social media platform he plans to buy for $44 billion, which is about $44 billion more than most people will ever have. Take a look at how Musk responded to a tweet from Netscape co-founder Marc Andreessen about another drug Adderall:
As you can see, Andreessen originally tweeted, “Everyone thinks our current society was caused by social media. I wonder if Adderall plus the ubiquitous Google searches have greater effects. Note that Andreessen, who is also not a doctor or other mental health professional, did not mention Wellbutrin. Nonetheless, Musk decided to throw in a well, how about the Wellbutrin type of response: “Wellbutrin is way worse than Adderall imo. It should be taken off the market. Every time this drug comes up in conversation, someone at the table has a story of suicide or near-suicide.
Presumably, Musk used “imo” to mean “in my opinion” rather than “fearless naval officer”, “smart medical object” or “I monetize otters”. Maybe it was a disclaimer in case someone accused him of offering medical advice. Anyway, on social networks, such a qualifier can go unnoticed, especially if we do not emphasize “imobidhrme”, which would mean “in my opinion because I do not have real expertise medical”. Remember when podcaster Joe Rogan said, “I’m not a doctor, I’m a beeping jerk” and “I’m not a respected source of information, even for me”, while covering for Forbes? Well, has that stopped people from following Rogan’s medical advice and does Rogan continue to make claims about Covid-19 vaccines and drugs such as ivermectin? Add over $260 billion and do you have a similar situation with Musk?
Let’s take a look at the details of what Musk tweeted. To say that Wellbutrin is worse than Adderall is like saying “a can opener is much worse than a hedge trimmer”. Of course, both drugs affect neurotransmitters, the chemicals your brain’s nerve cells use to communicate with each other. However, they belong to different categories of drugs. Wellbutrin, known generically as bupropion, is an aminoketone antidepressant or dopamine reuptake inhibitor, while Adderall, known generically as dextroamphetamine/amphetamine is a central nervous system (CNS) stimulant. The strengths, limitations, risks, and usefulness of Wellbutrin and Adderall really depend on the specifics of their use.
The two drugs also tend to be used for very different things. Doctors may prescribe Wellbutrin to treat either major depressive disorder or seasonal affective disorder, which is when episodes of depression tend to occur during the fall and winter months. Wellbutrin happens to contain the same active ingredient as the smoking cessation drug Zyban. So, doctors may also prescribe Wellbutrin off-label to help people trying to quit smoking.
Meanwhile, doctors tend to use Adderall to treat attention deficit hyperactivity disorder (ADHD) or narcolepsy. ADHD is not the same as depression, although a given person can have both conditions. With ADHD, you have great difficulty maintaining your attention, feeling hyperactive, and being impulsive. Keep in mind that there are formal criteria that mental health professionals use to diagnose ADHD. So don’t think you have ADHD just because you’re complaining that too many people on Tinder are looking for long-term relationships.
Narcolepsy is also not the same as depression. It is a chronic sleep disorder where you may have episodes of extreme drowsiness and suddenly fall asleep during the day. Again, narcolepsy is a formal diagnosis with specific criteria. Not staying awake after spending all night watching cat videos doesn’t necessarily mean you have narcolepsy.
Also, Musk saying Wellbutrin should be taken off the market is a pretty strong statement. The same goes for the use of words like “every time” and “everyone”. Remember that “every time” technically means every time. Be very skeptical whenever someone says “every time” or “everyone” about something scientific, especially anything medical. Instead, real scientists tend to use more precise words such as “usually”, “generally”, “more likely to” or “tend to” as well as “many people” or “a majority of people”. when referring to something that often happens like “when you drop a cinder block on your foot it tends to hurt” or “the majority of people don’t like sandpaper underwear “.
Why did Musk think Wellbutrin should be taken off the market? While his tweet appeared to suggest that use of the drug is associated with suicidal thoughts, Musk offered no scientific studies or solid data to back up his opinion. But Musk’s observations alone aren’t enough to draw that conclusion. Just because bitcoin pops up every time a friend mentions squirrels in a conversation doesn’t mean squirrels somehow control the crypto market. Similarly, Musk’s observations are not only undocumented, but may also be skewed. When Musk said, “Every time this drug came up in a conversation, someone at the table,” who exactly was Musk talking to, what kind of conversations were going on, and what kind of table was it? Was it one of those very small tables that are used in kindergartens? Would his opinions have as much weight if he was just a guy and not a billionaire?
A clear confounder is that those taking Wellbutrin are likely to be suffering from depression, which in some cases may be accompanied by suicidal thoughts. So just because such thoughts arise doesn’t necessarily mean they’re the result of the drug. You don’t know bandages cause bleeding, do you?
The National Library of Medicine (NLM) lists a number of possible side effects for bupropion, ranging from drowsiness and headaches to nausea and vomiting, anxiety, trouble sleeping, uncontrollable shaking part of the body, loss of appetite, excessive sweating and seizures. confusion hallucinations irrational fears irregular heartbeats. This certainly does not mean that everyone or even most people will experience all of these side effects. This means that you should not take Wellbutrin alone without the expert advice of a genuine mental health professional qualified to prescribe and monitor your use of Wellbutrin. Wellbutrin is not like chicken wings. You shouldn’t just take one when you’re feeling down. (Although you may want someone else to monitor your wing usage as well.)
Many mental health professionals on Twitter pushed back against Musk’s claims. For example, Jessi Gold, MD, MS, an assistant professor in Washington University’s Department of Psychiatry at St Louis School of Medicine, tweeted that Wellbutrin is “one of my patients’ favorite medications” and that herself has been on the drug:
And David Reiss, MD, a psychiatrist in San Diego, Calif., called Musk’s tweet “DANGEROUS medical misinformation” and pointed out that “any antidepressant can be dangerous if not prescribed correctly and monitored closely” in the following tweet:
Meanwhile, those who said they had undergone treatment for depression also responded. For example, Matthew Cortland, a lawyer, urged, “Please don’t follow Elon Musk’s medical advice,” and offered the following:
He emphasized the “need to increase access to ALL depression treatments” in the rest of his thread:
Cortland also pointed to a sentence, “It should be noted that the risk of attempted suicide is inherent in major depression and may persist until remission”, which appeared in the medical reference. Up to date:
Author Stephanie Land wrote that “Wellbutrin has changed my life. It probably saved him a bit too” in the following tweet:
Of course, Wellbutrin and Adderall aren’t for everyone. And as with many different drugs, there are probably a number of people taking such drugs who really don’t need to take them. At the same time, some people who could benefit from these drugs may not currently have access to them. Either way, blaming all of the company’s problems on social media, Adderall, Google searches, or Wellbutrin alone greatly simplifies things and really overlooks the complex system of contributing factors. And a big part of the problem has been our society’s steady shift over the past decades away from investing in, respecting, and following real science and real scientists.