Understanding Wellbutrin, The Drug At The Center Of Elon Musk's Recent Twitter Controversy

Content warning Please note this article references potential trauma triggers, including depression, anxiety, suicide, and suicidal ideation. If you are in distress and need immediate help, trained counselors are available to take your call. Please find a crisis hotline in your country here.

Elon Musk, CEO of SpaceX and Tesla and Twitter’s largest shareholder, recently courted controversy by tweeting his critical opinion of two psychiatric drugs — mainly the antidepressant Wellbutrin (bupropion).

On April 30, 2022, Musk tweeted: "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."¹

Musk’s comment was in response to a tweet from venture capitalist and Netscape co-founder Marc Andreessen.

"Everyone thinks social media caused our present society. I'm wondering whether Adderall plus ubiquitous Google searches have bigger effects," mused Andreesen, the day before Musk’s remarks.²

(Adderall is a drug that doctors prescribe to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy).

Musk's reply and ill-informed opinion generated significant backlash from medical experts and various members of the Twitter community (many of whom shared their personal experiences with Wellbutrin).

Medical doctor and Yale professor Howard Forman joined the conversation, pointing out flaws in Musk’s reasoning, and tweeted at him rhetorically:

“Maybe because Wellbutrin is used to treat depression and depressed people have a higher likelihood of suicide, to begin with?”

“By your logic, maybe we should take cancer drugs off the market, too, since so many of the patients die of cancer?”

Separating opinions from facts in a heated tweetstorm like this can be confusing — especially when the opinion comes from someone with as much reach and influence as billionaire Musk.

This article aims to clear up any confusion and provide an overview of what you need to know about Wellbutrin and its health effects.

What to know about Wellbutrin (bupropion)

Wellbutrin (generic name bupropion) is a psychiatric medication invented by GlaxoSmithKline. It was approved by the US Food and Drug Administration (FDA) in 1985.³

Wellbutrin is used mainly for treating major depressive disorder (MDD), mood disorders, and anxiety.

Typically, doctors use a different class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) as the first line of treatment for depression and anxiety.⁴

Common SSRIs are fluoxetine (Prozac) and escitalopram (Lexapro).

SSRIs work by influencing the serotonin pathways in the brain. Serotonin is a neurotransmitter (chemical messenger) believed to positively influence mood, emotional regulation, and sleep.⁴

If a doctor deems SSRIs unsuitable for a certain individual — perhaps due to side effects, adverse interactions with the other medications, or ineffectiveness, Wellbutrin may be prescribed instead. Wellbutrin belongs to a class of medications known as norepinephrine-dopamine reuptake inhibitors (NDRIs). 

Unlike SSRIs, which influence serotonin, NDRIs like Wellbutrin target norepinephrine, and dopamine. Together, these neurotransmitters regulate stress response, sleep, motivation, and the ability to experience a pleasure.⁵ ⁶

Bupropion is sometimes prescribed for smoking cessation (in which case it is marketed as Zyban) and for treating attention-deficit hyperactivity disorder (ADHD).⁷

In 1997, the FDA approved bupropion to help cigarette smokers quit. Using Wellbutrin to treat ADHD is not FDA-approved, though doctors do prescribe it. This practice is considered “off-label” use, meaning the drug is used in a way that differs from the intended use.

Some of the most common side effects of taking SSRIs include weight gain and sexual dysfunction. 

Notably, in four different clinical trials, Wellbutrin was associated with less sexual dysfunction (and more sexual satisfaction) than experienced by participants taking sertraline (Zoloft) or fluoxetine (Prozac).⁸

One large 2016 systematic review and meta-analysis used data from 51 studies spanning 20 years to examine Wellbutrin’s effectiveness in treating depression.⁵ The findings support a therapeutic role for bupropion, either a sole treatment (or prescribed with another antidepressant), “especially if there is concern about weight gain and sexual dysfunction side effects from other medications.”⁵

If you are taking Wellbutrin it's crucial to follow your doctor's instructions precisely.  It may take a month or longer to feel the medication results. Do not stop taking Wellbutrin without talking to your doctor, even if you feel well. 

Wellbutrin and suicide

Emergency psychiatrist, suicidologist, and psychopharmacologist Dr. Tyler Black also criticized Musk, tweeting:

“You are absolutely off base here and your uninformed opinions here are against the evidence.” 

Black implored the business magnate to “demonstrate the ability to learn,” and pointed Musk to a 2010 meta-analysis examining Wellbutrin and suicidality — which found that there was no significant difference in suicidal ideation or behaviors between those who received Wellbutrin and the placebo groups.⁹ ¹⁰

It’s essential to note that antidepressants in general (not just Wellbutrin) include a black box warning (boxed warning) which explains that they can cause an increased risk of suicidal thoughts and behaviors as a side effect — especially at the start of treatment.

Doctors who prescribe Wellbutrin are also responsible for explaining this (relatively small) risk and potential benefits before one starts taking any antidepressant/antipsychotic medication.

The baseline risk of suicide is higher in individuals with mental illness than in the general population, whether or not they are taking any form of psychiatric medication.¹¹

Attempted and completed suicides occur at a rate of 0.1–1% in people taking Wellbutrin.¹²

The FDA’s decision to implement a black box warning happened in 2004 after the organization conducted a meta-analysis of antidepressants in 300+ randomized clinical trials with approximately 100,000 participants.¹³

Their researchers found that rates of suicidal ideation and behaviors were higher in patients taking antidepressants than in placebo groups. 

There was also a significantly increased risk in children and adolescents under the age of 18 compared to older age groups. 

In adults over 24 years old, there was no elevated risk. In fact, there was a protective effect against suicidal thoughts and behaviors amongst adults 65 years old and up.

Experts have questioned the validity of this analysis performed by the FDA, citing issues with the methodology — namely that the trials analyzed were not designed primarily to assess suicidality.¹⁴

This limitation may have skewed conclusions.

Balancing the risks and benefits of Wellbutrin

The conversation surrounding Wellbutrin and other antidepressants’ link to suicide risk remains a contentious topic even amongst the medical community.

The relationship is not straightforward, and so far, there are inconsistencies in the results of various clinical studies.

Additionally, suicidal ideation and behaviors can be a symptom of severe mental illnesses. So it can be difficult to discern whether these symptoms are part of a disorder or a side effect of medication.

Several experts suggest that the current presence of a black box warning about the suicide risk on antidepressants is unnecessary and that it may do more harm than good.¹⁴

Others feel that the FDA should provide a more accurate representation of the current research — which is that the association with suicide risk warrants further rigorous research.¹³

As with any pharmacological treatment, physicians need to weigh the risks and benefits of prescribing Wellbutrin based on the individual needs of their patients.

It’s important that doctors present this information in a balanced way because missing out on treatment comes with its own risks — untreated mental illness can lead to increased suicidal thoughts and behaviors.¹⁵

Signs of suicidality

If you are being treated with Wellbutrin, or care for someone taking Wellbutrin, contact your doctor right away if there are changes to mood or behavior.

Signs of suicidality might include:

• Speaking about suicide or dying

• Worsening or new anxiety/depression/irritability

• Agitation/restlessness

• Difficulty sleeping

• Increased alcohol or drug use

• Unusual, aggressive, or violent behavior

• Isolating oneself from family and friends

The lowdown

When contemplating health-related information, it’s always important to consider the source. While Elon Musk is business-savvy, he is not a trained medical expert. It’s essential to talk with a qualified doctor about the risks and benefits of treating any mental health condition with any antidepressant, including Wellbutrin. Following a detailed discussion of your condition, symptoms, and medical history, your doctor will guide you in determining which treatment is right for you.

If you experience clinical depression or any other form of mental illness there is an increased risk of becoming suicidal, whether medicated or not.

Suicide risk is also higher when starting a new course of antidepressants, or when the dosage has recently been increased or decreased. Frequent follow-ups between patient and doctor are strongly advised.¹⁶

While more research into Wellbutrin and suicide risk is necessary, appropriate monitoring of individuals at the initial stages of drug therapy is also vital.

If you're currently taking any form of antidepressant and are concerned about suicide risk, speak with your doctor or healthcare professional so they can address your concerns and offer solutions in a personalized way. Do not stop taking medication unless instructed to do so by your physician. If you are in distress, help is available. Please find a crisis hotline in your area here. 

The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and their existing health care professional(s).

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