Elon Musk is not a medical doctor. He’s not a psychiatrist or any other type of mental health professional. But on Friday, he expressed a very strong opinion about Wellbutrin, an anti-depressant medication, on Twitter. Yes, Twitter, that social media platform that he plans on buying 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 a different medication Adderall:
As you can see, Andreessen had originally tweeted, “Everyone thinks our present society was caused by social media. I’m wondering whether Adderall plus ubiquitous Google searches have bigger effects.” Note that Andreessen, who’s not a medical doctor or other mental health professional either, didn’t mention Wellbutrin. Nevertheless, Musk decided to throw in a well, how about Wellbutrin type of reply: “Wellbutrin is way worse than Adderall imo. It should be taken off the market. Every time that drug has come up in conversation, someone at the table has a suicide or near suicide story.”
Presumably, Musk used “imo” to stand for “in my opinion” rather than “intrepid marine officer”, “intelligent medical object”, or “I monetize otters.” Maybe this was a disclaimer just in case someone accused him of offering medical advice. Regardless, on social media, such a qualifier may go unnoticed, especially if you don’t emphasize “imobidhrme,” which would stand for “in my opinion because I don’t have real medical expertise.” Remember when podcaster Joe Rogan said, “I’m not a doctor, I’m a bleeping moron,” and “I’m not a respected source of information, even for me,” as I covered for Forbes? Well, has that stopped people from taking medical advice from Rogan? And has that kept Rogan from continuing to make claims about Covid-19 vaccines and medications such as ivermectin? Add over $260 billion in net worth, and do you have a similar situation with Musk?
Let’s take a look at the specifics of what Musk tweeted. Saying that Wellbutrin is worse than Adderall is a bit like saying, “a can opener is way worse than a hedge trimmer.” Sure, both medications do affect neurotransmitters, the chemicals that nerve cells in your brain use to communicate with each other. However, they do fall into different categories of medications. Wellbutrin, known generically as bupropion, is an aminoketone antidepressant or a dopamine reuptake inhibitor, whereas Adderall, known generically as dextroamphetamine/amphetamine is a central nervous system (CNS) stimulant. The strengths, limitations, risks, and usefulness of both Wellbutrin and Adderall really depend on how specifically they are being used.
The two medications tend to be used for very different things too. Doctors may prescribe Wellbutrin to treat either major depressive disorder or seasonal affective disorder, which is when depression episodes tend to come in the Fall and Winter months. Wellbutrin happens to have the same active ingredient as the smoking cessation medication Zyban. Thus, doctors may also prescribe Wellbutrin in an off-label manner to help people trying to quit smoking.
By contrast, doctors tend to use Adderall to treat either attention deficit hyperactivity disorder (ADHD) or narcolepsy. ADHD is not the same as depression, although a given person may have both conditions. With ADHD, you have a lot of difficulty with maintaining attention, experiencing hyperactivity, and being impulsive. Keep in mind that there are formal criteria that mental health professionals use to diagnose ADHD. So don’t think that you have ADHD just because you complain that too many people on Tinder are looking for long-term relationships.
Narcolepsy isn’t the same as depression either. It’s a chronic sleep disorder where you can have episodes of being extremely drowsy and suddenly falling asleep during the daytime. Again narcolepsy is a formal diagnosis with specific criteria. Not being able to stay awake after you’ve spent the whole night watching cat videos does not necessarily mean that you have narcolepsy.
Moreover, Musk saying that Wellbutrin should be taken off the market is a pretty strong statement. So is using words like “every time” and “everyone.” Remember “every time” technically means every single time. Be very skeptical whenever anyone says “every time” or “everyone” about anything scientific, especially anything medical-related. Instead, real scientists tend to use more accurate words such as “usually”, “typically”, “more likely to”, or “tends to” as well as “many people” or “a majority of people” when referring to something that happens often, such as, “when you drop a cinder block on your foot, it tends to hurt” or “a majority of people do not like underwear made out of sandpaper.”
Why did Musk think that Wellbutrin should be taken off the market? While his tweet seemed to suggest that using the medication is associated with suicidal thoughts, Musk did not offer any scientific studies or hard data to justify his opinion. But Musk’s observations alone are not enough to make that conclusion. Just because bitcoin comes up every time a friend has mentioned squirrels in conversation doesn’t mean that squirrels are somehow controlling the crypto market. Similarly, Musk’s observations not only are undocumented but can also be skewed. When Musk said, “Every time that drug has come up in conversation, someone at the table,” whom exactly was Musk talking to, what kind of of conversations were occurring, and what kind of table was it? Was it one of those really small tables that are used in kindergartens? Musk’s tweet didn’t say, “imbo” for “in my billionaire’s opinion” but would his opinions carry as much weight if he were just some dude and not a billionaire?
One clear confounding factor is that those who are taking Wellbutrin likely have depression, which in some cases can have accompanying suicidal thoughts. So, just because such thoughts arise doesn’t necessarily mean that they are the result of the medication. You don’t claim that bandages cause bleeding do you?
The National Library of Medicine (NLM) does list a number of possible side effects for bupropion ranging from drowsiness to headaches to nausea and vomiting to anxiety to sleep disturbances to uncontrollable shaking of a part of the body to loss of appetite to excessive sweating to seizures to confusion to hallucinations to irrational fears to irregular heartbeats. This certainly doesn’t mean that everyone or even most people will experience all of these side effects. It does mean though that you shouldn’t be taking Wellbutrin on your own without the close guidance of a real mental health professional who is qualified to prescribe and monitor your use of Wellbutrin. Wellbutrin ain’t like chicken wings. You shouldn’t just take one when you are feeling down. (Although, you may want someone else to monitor your use of chicken wings too.)
Plenty of mental health professionals on Twitter pushed back on Musk’s assertions. For example, Jessi Gold, MD, MS, an Assistant Professor of Psychiatry at Washington University in St Louis School of Medicine, tweeted that Wellbutrin is “one of the most favored meds by my patients” and that she herself has been on the medication:
And David Reiss, MD, a psychiatrist in San Diego, CA, called Musk’s tweet “DANGEROUS medical misinformation” and emphasized that “any antidepressant can be dangerous if not appropriately prescribed and closely monitored” in the following tweet:
Meanwhile, those who said that they have undergone treatment for depression chimed in as well. For example, Matthew Cortland, a lawyer, urged, “Please do not take medical advice from Elon Musk,” and offered the following:
He emphasized the “need to increase access to ALL depression treatments” in the rest of his thread:
Cortland also highlighted a sentence, “Of note, the risk of a suicide attempt is inherent in major depression and may persist until remission occurs,” that appeared in the medical reference UpToDate:
Then there was author Stephanie Land, who wrote that “Wellbutrin changed my life. It probably saved it a bit too” in the following tweet:
Of course, Wellbutrin and Adderall are not for everyone. And as with many different medications, there are likely a number of people who are on such meds who really don’t need to be on them. At the same time, there may be people who could benefit from these medications that currently don’t have access to them. Regardless, blaming all of society’s problems on social media, Adderall, Google searches, or Wellbutrin alone greatly oversimplifies matters and really overlooks the complex system of contributing factors. For example, existing and widening socioeconomic disparities are major factors. And so has our society’s steady shift over the past several decades away from investing in, respecting, and following real science and real scientists.