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Experts on why Elon Musk’s antidepressant tweet ‘puts people at risk’

Elon Musk at the Met Gala in New York on May 2. (Andrew Kelly/Reuters)
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Elon Musk’s recent tweets reflecting what medical experts say are poorly informed opinions about mental health medication — including one tweet that called for a widely used antidepressant to be pulled from the market and another touting the benefits of psychedelics over prescription drugs — prompted swift backlash from patients, mental health providers and others concerned about the tech billionaire’s outsize public influence.

“Elon Musk has a tremendous number of followers, and he’s very unique in that many of his followers believe that he is a super-genius who should be believed over pretty much everyone else,” said Tyler Black, a pharmacologist and clinical assistant professor of child and adolescent psychiatry at the University of British Columbia. Musk, chief executive of Tesla, acquired Twitter for $44 billion in April and has expressed interest in opening up the social media platform for “free speech,” which critics say could lead to a rise in the sharing of misinformation, among other issues.

When Musk tweets out an opinion about medications to his more than 90 million followers, “he puts people at risk, because there’s going to be a number of people who believe him,” Black said.

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Replying to a tweet Friday that included an excerpt of a 2016 New York Times Magazine article titled “Generation Adderall,” Musk wrote: “Wellbutrin is way worse than Adderall [in my opinion].” Wellbutrin is a brand name of bupropion, a prescription antidepressant approved by the Food and Drug Administration in 1985 that is sometimes used to treat attention-deficit/hyperactivity disorder, or ADHD. Adderall is often prescribed for ADHD.

“It should be taken off the market,” Musk added about Wellbutrin. “Every time that drug has come up in conversation, someone at the table has a suicide or near suicide story.”

In response, many people, including health-care professionals, shared personal experiences about how taking Wellbutrin has helped them. Meanwhile, some mental health experts were quick to highlight the medicine’s safety and effectiveness, imploring people to rely on trained medical providers for guidance.

“It is extremely distressing that a man who blithely tosses off [uninformed] opinions about medicine is poised to acquire this entire platform,” tweeted Daniel Summers, a pediatrician.

Black called Musk’s comments on Wellbutrin “basically medical misinformation.” The drug has been approved “on the basis that it works and its benefits outweigh its harms, so unquestionably what he shared had the effect of misinformation,” he said.

Musk did not respond to a request for comment.

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Bupropion is approved for the treatment of adult depression and seasonal affective disorder, and to help people stop smoking. Experts say there is robust safety and efficacy data supporting its use; a scientific review of bupropion published in 2005 estimated that it was being used by more than 40 million people worldwide at the time.

It is considered an “atypical antidepressant” because it acts on the neurotransmitters dopamine and norepinephrine, said Jessi Gold, an assistant professor in the department of psychiatry at Washington University School of Medicine in St. Louis. Gold, who has been taking Wellbutrin for more than 10 years, added that the medicine is preferred by some people because it can increase energy, does not typically lead to weight gain and can cause weight loss, and has a lower risk of sexual side effects.

There have, however, been reports of seizures associated with the medication, though the risk is generally low, according to the National Alliance on Mental Illness. The risk of seizures increases, in part, with higher-than-recommended doses. Additionally, the energy-boosting effect can make some people feel more anxious, Gold said. Like other approved antidepressants, Wellbutrin also carries a serious FDA warning about the risk of suicidal thoughts or actions.

“Bupropion itself has a very small to absent suicide risk signal, and though we still recommend monitoring when you’re starting it, it certainly isn’t an antidepressant or even an ADHD medication that’s more associated with suicide,” Black said.

Black also noted the difficulty of attributing suicides or suicidal ideation to medication. “The reason people are starting medications are often because their situation is getting more desperate,” he said. “We can’t tease out the difference between the cause of the suicidality being the start of the medication or the reason that the medication was started.”

National Suicide Prevention Lifeline is 800-273-TALK (8255)

It isn’t clear why Musk weighed in on the prescription drug. “I imagine in Elon’s brain, he was hoping to help people,” Black said. “But, of course, the unintended consequences of telling people that Wellbutrin is scary could be very harmful.”

After sharing his thoughts on Wellbutrin, Musk continued to fire off tweets about medications. He responded to a Twitter user’s question about Ritalin, another prescription medication for ADHD symptoms. Then, in a separate tweet, he wrote, “I’ve talked to many more people who were helped by psychedelics & ketamine than SSRIs & amphetamines,” referring to selective serotonin reuptake inhibitors, which are the most commonly prescribed antidepressants.

“Psychedelics and ketamine, in a lot of ways, are still in early testing,” Gold said.

Black added that despite the ongoing research, “psychedelics are not yet the first-line treatments for anything in psychiatry, and they may never be, because the evidence won’t support them.”

Health misinformation or unsound opinions that can be interpreted as medical advice shared by influential public figures, such as Musk, could have wide-reaching repercussions, said Steven Hoffman, a professor of global health, law and political science at York University in Toronto who has published research on how celebrities influence people’s health decisions.

Hoffman said the influence can result from psychological, sociological and biological factors, with admiration acting as a “key mechanism.” For instance, people who admire Musk are more likely to trust his views on topics such as medications, despite his lack of expertise.

“If some people feel that the medicine that their physician has prescribed them is not going to work or could lead to suicides like Elon Musk alleges, then that might encourage patients to stop taking their medicine,” he said. “It could also encourage patients to seek alternative medicines that Elon Musk is recommending through illegal channels, which could be also quite dangerous.”

And the effect could spread beyond Musk’s fans as his opinions continue to gain exposure through retweets, likes, media coverage and public discourse. As information spreads, the original source is not always clear and details can become distorted, Hoffman said.

“There’s going to be many conversations around many kitchen tables across the nation where people are going to start talking about Wellbutrin and Adderall and psychedelics,” he said. “Those hearing that information at the kitchen table won’t realize that it started with Elon Musk’s tweet.”

Musk should be aware of these potential ramifications, Black said. “I really hope that in his constant quest for free speech, he recognizes that all speech is not harmless.”

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). You can also text a crisis counselor by messaging the Crisis Text Line at 741741.

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