Elon Musk doesn’t practice as a doctor. He’s not a psychiatrist or any other type of mental health professional. On Friday, however, he voiced a strong opinion on Wellbutrin (an antidepressant medication) on Twitter. Musk plans to purchase Twitter for $44Billion. That’s $44Billion more than what most people have. Look at Musk’s response to Marc Andreessen, Netscape founder about an alternative 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 needs to be taken off the marketplace. 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 SME? Rogan has stopped Rogan from giving medical advice to people. Rogan has stopped making claims about Covid-19 vaccinations and medication such as ivermectin. Musk is in a similar position if you add more than $260 billion to your net worth.
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. They do however fall under different types of medication. 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 effectiveness, strengths, risks, and utility of Wellbutrin as well as Adderall depend on their specific usage.
They are often used for completely different purposes. Wellbutrin can be prescribed to either treat major depressive disorder (MDD) or seasonal affective disorder (SAD), which refers to the fact that depression symptoms are most common during winter and fall months. The active ingredient in Wellbutrin is the same as Zyban, which can be used to quit smoking. To help patients quit smoking, Wellbutrin may be prescribed by doctors in an unapproved manner.
Doctors tend to prescribe Adderall for the treatment of attention deficit hyperactivity disorder (ADHD), or narcolepsy. ADHD does not mean that you have depression. However, a person could be suffering from both. ADHD can cause attention problems, hyperactivity and impulsiveness, as well as difficulty maintaining focus. Mental health professionals can diagnose ADHD using formal criteria. 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. Narcolepsy can be diagnosed 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.
Musk’s assertion that Wellbutrin should not be on the market was a strong one. So is using words like “every time” and “everyone.” Remember “every time” technically means Each and every one 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.”
Musk believed Wellbutrin should not be on the market. Musk’s tweet suggested that Wellbutrin use is linked to suicidal thinking, but he didn’t provide any hard evidence or scientific studies to support his assertion. 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? Did it have one of those tiny tables found 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?
A common confounding factor for Wellbutrin users is their depression. In some instances, this can lead to 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?
Bupropion may cause nausea, headaches and drowsiness. 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. (Of course, it is possible to have someone monitor the consumption of your chicken wings.
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:
Many others also shared their stories of depression treatment. 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 Stay up-to-date:
Then there was author Stephanie Land, who wrote that “Wellbutrin changed my life. It probably saved it a bit too” in the following tweet:
Wellbutrin, Adderall and other meds aren’t for everybody. 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. Major factors include the growing and existing socioeconomic inequalities. 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.