When the richest man in the world casually cast doubt on medications that help millions through psychological distress over the weekend, his comments met fierce resistance.
On Saturday, Tesla CEO and future Twitter owner Elon Musk brayed to his 90 million followers: “Wellbutrin is way worse than Adderall imo. It should be taken off the market,” Musk wrote in reply to venture capitalist Marc Andreessen, who had wondered aloud if “Adderall plus ubiquitous Google searches” had poisoned the attention span of society at large.
“Every time that drug has come up in conversation, someone at the table has a suicide or near suicide story.” Musk proclaimed.
If people taking antidepressants followed Dr. Elon’s advice and stopped the medication the day his tweet went out, they’d put themselves at risk of becoming more suicidal, not less, multiple doctors told Gizmodo.
“If there was anyone who was influenced by Elon Musk who was on an antidepressant like Wellbutrin, and then they decided, ‘You know what, Elon doesn’t like this medication. I’m going to stop taking it,’ they could experience really significant side effects,” Dr. Tyler Black, a clinical assistant professor at the University of British Columbia and a practicing hospital psychiatrist, told Gizmodo. “Fortunately, if you’re on the lowest dose, the withdrawal risk is very low. But if you’re on one of the higher doses and you stop it cold turkey, you can go through some real medical problems, including suicidality.”
The tech magnate’s comments, especially the overstatement of Wellbutrin’s suicide risk, prompted worry, frustration, and anger among doctors and patients on Twitter, who pushed back against his anecdotal assertions and pointed out that these medications have led millions away from despair. An expert called the comments misinformation in an interview, while others said it seemed like Musk had launched an anti-psychiatry attack. Patients came out in force, sharing how the medications had saved their lives.
Doctors told Gizmodo that Musk’s tweets could harm individuals in vulnerable states and fuel already prevalent prejudice against psychiatric medications. Meanwhile, a misinformation expert said Musk’s comments could increase medical misinformation online.
Twitter declined to comment for this story and representatives for Musk did not respond to requests for comment by the time of publication.
Patients spoke up, too. Rep. Ritchie Torres, Democrat of New York, tweeted that he has been taking Wellbutrin every day for more than a decade.
“I would not be alive today, let alone a member of Congress, were it not for Wellbutrin, which saved my life,” Torres said. “Mr. Musk might know many things but psychopharmacology is not one of them. No psychiatric drug works for every person in every case. But Wellbutrin has success stories, and I am one of them.”
Dr. Amy Barnhorst, a psychiatrist in Sacramento, California and the vice chair for community mental health at the UC Davis Department of Psychiatry, was one of many doctors who responded to Musk’s tweets—in her case, with dry medical sarcasm: “TPA is way worse than aspirin imo. It should be taken off the market. Every time that drug has come up in conversation, someone at the table has a stroke or near stroke story.” TPA is “tissue plasminogen activator,” a drug that restores blood flow to the brain after a stroke.
Barnhorst told Gizmodo that when she saw Musk’s tweets, her first reaction was: “Oh no, this is bad.” She said that it’s hard to know whether the billionaire knew what he was doing or if he had no idea the impact his words could have.
“People assume that his opinion is an expert opinion because he has been successful in other realms. The things he says, whether they’re true, whether they’re researched, whether he put any thought into them at all before he tweeted them, they get read by a lot of people or heard by a lot of people, and people take him seriously,” Barnhorst said.
Despite Musk’s comment claiming that every time he’s spoken about the medication “someone at the table has a suicide or near suicide story,” Black told Gizmodo that there is no specific signal to suggest that Wellbutrin causes suicidality. While it does have an FDA black box warning—a warning put on prescription drug labels with potential serious or life-threatening risks—the Vancouver psychiatrist said that this was included only out of an abundance of caution.
“It’s definitely the best medical advice when you’re starting an antidepressant to follow up and make sure that there aren’t new suicidal thoughts. But the reason behind that is more complex because, of course, the reason that we’re often starting medication is because depression is worsening in the first place,” Black, who specializes in suicide research, said.
Approved by the Food and Drug Administration in 1985, Wellbutrin is patented by GlaxoSmithKline and is approved to treat depression, seasonal affective disorder, and smoking cessation. It’s also used off-label to treat ADHD. It’s an antidepressant prescribed for people who don’t tolerate the standard class of medications for anxiety and depression, known as selective serotonin reuptake inhibitors, Black explained, and is less likely to cause unwanted sleepiness or hamper the libido.
GlaxoSmithKline did not respond to Gizmodo’s requests for comment on Musk’s tweets.
Doctors weren’t the only ones to rebuke Musk’s claims about Wellbutrin on Twitter (and, to a seemingly lesser extent, Adderall and Ritalin), patients and caregivers spoke up as well. Others spoke about how Wellbutrin helped them treat their depression or helped their loved ones; some even credited the medication with saving their lives.
One who spoke out was Dr. Daniel Summers, a primary care pediatrician who works just outside of Boston. Summers currently takes Wellbutrin, primarily for ADHD, and has prescribed it to his patients.
He told Gizmodo via email that it really makes a difference in helping him stay on task. He said he’s glad he’s on the medication, and Musk’s tweets made him angry and frustrated. He pointed out that the Tesla CEO’s comments could discourage any number of his millions of followers from getting the help they need. However, Summers was heartened by the amount of people who spoke up and shared their own mental health diagnoses and talked about treatments that helped them.
“We need far more of that kind of conversation, to help break down the barriers that still exist for some people in getting treatment that could really help them,” Summers said.
Black, the Vancouver psychiatrist, explained that Musk’s comments about Wellbutrin seemed to have especially hit a nerve because people who take antidepressants are often criticized for doing so.
“It’s not just Elon Musk’s comments,” Black explained. “Online, there’s a whole bunch of anti-medication [discourse]. It’s almost like a form of ableism, where people are told basically, ‘Oh, you’re taking a lazy shortcut when you take medications because you’re not good enough to battle your depression on your own.’ And so, Elon’s tweet almost adds to this barrage of shame that gets put on people who take medication.”
Misinformation about psychiatric medications and mental illness, like disdain, is widespread on social media. Timothy Caulfield, a Canada Research Chair in Health Law and Policy at the University of Alberta who studies health misinformation, told Gizmodo that researchers know that comments by people like Musk, as well celebrities and other high profile individuals, can have an impact on public perception of pharmaceuticals and their value.
One recent example of this is the drug ivermectin, Caulfield pointed out, an antiparasitic drug that has been adopted as a treatment for covid-19 despite the fact that there is currently little evidence that the medication prevents or treats the disease.
“We know that the perceived value of ivermectin was driven largely by social media discussions, by non-experts,” Caulfield told Gizmodo. “There’s a lot of examples of how that led to not just noise on social media, but actual clinical uptake of ivermectin.”
Caulfield said he considers Musk’s comments on Wellbutrin and other psychiatric medications misinformation because of how they are framed as a whole. Caulfied sees Musk’s overall message as “Wellbutrin is always bad and often results in suicide,”—coupled with the SpaceX’s CEO’s comments that psychedelics are better than certain psychiatric drugs—as misinformation, the researcher said. Caulfield also pointed out that Musk doesn’t qualify his anecdotes as what they are, instead making them sound like convincing evidence.
The entire Musk incident, he said, highlights how important it is to debunk misinformation, no matter how absurd people might think it is.
“These conversations that push back matter. They matter and they can make a difference,” Caulfield said.
As far as fighting misinformation like that spewed by the tech billionaire, Caulfield points out that there are a number of steps that need to be taken, including involving regulators and the social media platforms themselves. (Gizmodo reached out to Twitter and asked the company if Musk’s tweets violated its misleading information policy. The company, which Musk has entered into a deal to buy, declined to comment.)
Caulfield doesn’t recommend Musk be deplatformed—and it’s unlikely he would in this case since he might own Twitter in the near future—or that the tweets be deleted. Labeling the misinformation with a redirect to accurate information would be one possible option, Caufield said. A rapid response is also a good option, he said, noting that it has already been done here.
For those who have seen Musk’s tweets and have questions, Barnhorst, the psychiatrist from Sacramento, recommended they find someone who is knowledgeable about depression, ADHD, and psychiatry in general. It can be your physician, she said, your psychiatrist, or someone trained in those fields.
“It’s fine to have concerns. Our medications in psychiatry are not perfect,” Barnhorst said. “Some people have bad side effects, some people don’t like them, and sometimes they’re just plain not effective. But they can be really effective. They can be very safe and they can be worth whatever small side effects for many people if it treats their depression or their ADHD in an effective way.”