According to a 2023 statistic, Wellbutrin is the 3rd most common antidepressant prescribed in the United States.

It’s frequently offered as an alternative to SSRIs like Prozac and Lexapro. SSRIs suppress orgasm and libido, as the orgasm reflex is controlled by serotonin in the pelvic part of the spinal cord. By altering the concentration of serotonin in the cerebrospinal fluid, SSRIs interfere with the orgasm reflex arc at the end of the spinal cord.

Wellbutrin, by contrast, doesn’t affect serotonin at all, so it has no sexual side effects. And it works immediately, bypassing the six-week waiting period for SSRIs to kick in.

SSRIs have other downsides, too, like chronic tiredness. For instance, Lexapro can make a person feel jet-lagged for months while taking it. This is often mistakenly blamed on the depression itself, when in fact it may be due to the SSRIs. Unfortunately, many psychiatrists and nurse practitioners do not even understand why SSRIs do this: the reason Lexapro or Zoloft can cause a jet lag feeling is that they can increase melatonin. The melatonin builds up from the excess serotonin. Serotonin readily converts into melatonin, as the two compounds are very similar and are only one metabolic step away from each other. (That’s why sero-tonin and melatonin both end in ‘tonin.’

I have encountered many psychiatrists who do not even know the full list of adverse effects of SSRIs: e.g., they can increase glaucoma risk, they can mildly lower dopamine tone, and they can slightly thin the blood. Thinned blood is especially an issue for elderly people with a fall risk, and yet it’s common to see a 77-year-old put on Lexapro by a family doctor who is unaware of this effect.

So again, for the reasons I’ve outlined above, Wellbutrin may be a good alternative to an SSRI.

However, it may not be a good choice for a very anxious person.

For example, I’ve seen it prescribed to people with PTSD, sometimes to override the sexual side effects from an SSRI. In my opinion, this is nearly always a mistake.

The reason why it is a mistake is part of the reason I chose to write this particular blog.

Wellbutrin is a stimulant, full stop.

It is a stimulant, and most people don’t know it is a stimulant. Even worse, most family doctors, psychiatrists, and nurse practitioners don’t know it. Wellbutrin is a cathinone, which is every bit as much a stimulant as an amphetamine. The plant ‘khat’— popular in South Africa, where its leaves are chewed— was the origin of all lab-made cathinones. Have you heard of bath salts, the street drug? Bath salts are also cathinones.

When Wellbutrin was first developed, it was designated a controlled medication in Russia. It remains a controlled medication in Russia today. Somehow, in the early 1970s, when Richard Nixon designated our list of controlled medications, Wellbutrin never made it on the list. But what is very interesting is that a very similar drug, diethylpropion— which sounds like Wellbutrin’s generic, bupropion— did make it on the list. Diethylpropion is available today (I have a couple of patients on it) and is a schedule IV controlled medication in the United States. It’s a bit older than Wellbutrin and was first marketed as an appetite suppressant in 1959.

So we have a strange situation in which two drugs with almost the same name, bupropion and diethylpropion, and one is a controlled medication, and the other isn’t.

Take note, I’m not arguing Wellbutrin should be avoided on these grounds. It’s a perfectly good medication and, as I have noted above, it is preferable to SSRIs in many instances.

But the history of the drug provides a lesson in how drug policy can be quite irrational. And it also provides a further, darker lesson: the reason for this may have to do with the pharmaceutical companies.

The story for me began when I discovered the real history of Wellbutrin, and I soon realized it is a bad choice for the very compulsive or very anxious, or for those with PTSD. (People with fight-or-flight reactivity do not belong on any stimulant, which can only make it worse.)

So I started taking my PTSD patients off of it, with great results. And many of them asked me: why didn’t their former provider know Wellbutrin wasn’t good for severe anxiety or PTSD? It was a good question, and I told them it was a good question. And I drove home from work wondering why hadn’t I known either? Why hadn’t I discovered Wellbutrin is a cathinone stimulant until years after I had finished residency?

Another thing I discovered was that a pharmaceutical company in the year 2000 had changed the generic name of Wellbutrin. Since 2000, it has been called bupropion. But prior to 2000, it was called amfebutamone. When I first saw that word, I was shocked. I asked around with my colleagues how many of them had heard the word. I literally asked a dozen psychiatrists and family doctors. Literally none of them had heard of the word amfebutamone.

Most of them said the same thing: they had learned Wellbutrin was an ‘NDRI,’ a norepinephrine dopamine reuptake inhibitor. And that Wellbutrin was like an SSRI except without serotonin. Like me, they believed that, because of the last letters ‘reuptake inhibitor’, Wellbutrin works in a similar way as SSRIs work.

But that is false.

We don’t really know the true mechanism of action of Wellbutrin. We know it does lots of things chemically, and so while we can say it blocks the DAT dopamine transporter, that doesn’t mean anything without context. Just calling it an ‘NDRI’ is using scientific jargon in an ambiguous way. For instance, Ritalin and cocaine both also block the DAT dopamine transporter. Should we call them NDRI’s? Why not? In fact, I’ve found a couple of places online where Ritalin is called an NDRI. But that’s absurd. Ritalin is obviously best labeled a stimulant. As I mentioned, Ritalin shares a mechanism of action with cocaine. Wellbutrin, it should be noted, also blocks DAT— like cocaine and ritalin.

And so, I do not doubt that ‘NDRI’ is a true descriptor of Wellbutrin’s effects, but I question that being the most appropriate title for it. It is a name that throws a fog of scientific ambiguity around the drug, and it conceals more than it reveals. It makes the drug sound very newish and scientific, rather than just stating what it is.  The name of a thing should come from a broad observation of what it does. Wellbutrin works instantly. The same day you take it. There’s no waiting period. It certainly doesn’t take six weeks to slowly remodel the synapse, as is the case with the SSRIs.  So it makes the most sense to just call it a cathinone stimulant.

So, I got even more curious. And I got to wondering, why was Wellbutrin suddenly regarded as an NDRI in the 1990s?

I think everything becomes clearer if we focus on the marketing, and follow the money.

Wellbutrin was first marketed for depression in 1985, right around the same time Prozac came out. Prozac— the first SSRI— was set to be a blockbuster for Eli Lilly. And that put Burroughs Wellcome, the company selling Wellbutrin, in direct competition with Eli Lilly. Additionally, cocaine and other stimulants were popular in the 1980s, and the feds reacted to this, and around 1990, there were many federal crackdowns on diet pills such as Appedrine and Fen-Phen. Thus, it would have benefited Burroughs Wellcome immensely to change the way Wellbutrin was talked about. They also had to temporarily pull it from the market when it had caused seizures in 1986, so a rebrand was in order.

But branding and rebranding should be a matter of marketing, not science. However, in the world of pharmaceuticals, there is an overlap between marketing and science. If a drug has five mechanisms of action, for instance, Big Pharma may choose to focus on just one of them. It may even be a minor mechanism, but Pharma may have strategic reasons to define the drug by this sole action.

And so what happened was the hyper-technical, hyper-scientific term ‘NDRI’ began to be used around 1990 to describe the action of Wellbutrin, rather than cathinone or stimulant. (The drug’s complex actions on a neuron were known, but the term NDRI wasn’t used before 1990 as far as I can tell.) Finally, later in the year 2000, the generic name was changed from amfebutamone to bupropion.

What we see here, I believe, is a consistent trend to distance Wellbutrin from its true identity as a stimulant.

After 1997, it had gained an FDA indication for smoking cessation, and so there was (I conjecture) further motivation to distance it from its true identity as a stimulant. In the late 1990s, Big Tobacco had become the enemy, and after all, it’s sort of odd to sell a stimulant to treat tobacco addiction, right at a time when tobacco companies were viewed as evil for promoting addiction. In this context, you can see why in 2000, the name amfebutamone was changed to bupropion.

I have done extensive searching and cannot find any more plausible reason why the drug’s name was changed. It is extremely rare, by the way, for a generic drug to have a name change.

I’ve also done my best to find out whether the term ‘NDRI’ was used prior to 1989, and I can barely find any instance. In the 1960s and 1970s, as far as I know, the term was non-existent. So again, it appears that right as Prozac was marketed as an SSRI, we began using another term that mimicked that acronym.

Was it fidelity to neuroscience that brought this about? It doesn’t seem like it. What it seems like is that it was a scientific acronym that is technically correct, but which obscured the fact that Wellbutrin is a stimulant. It seems the decision was driven by a drug marketing strategy. And the ‘scientific’ education of psychiatrists is also part of drug marketing strategy. In the 1990s, Prozac was marketed on the basis of a supposed chemical imbalance in the brain, but this has never been substantiated by good science. The phrase was a pseudo-scientific fib that trickled into psychiatry education and into the pop culture landscape. Unfortunately, it remains with us today. I have encountered countless people who falsely believe they just have bad genetics, or have a lifelong problem with brain chemistry. Fraudulent marketing slogans can harm the self-esteem of millions of people.

And in 2013, Glaxo Smith Kline did in fact pay a $3 billion settlement related to fraudulent marketing of Wellbutrin.

So to summarize, what happened in 1989 was that during the era of crackdowns on cocaine and diet pills, Big Pharma was motivated to erase Wellbutrin’s identity as a stimulant.

In the 1960s, 1970s, and 1980s, it was common knowledge among physicians that you could treat depression with a stimulant. But today, few clinicians believe this. For example, today it is not considered good practice to prescribe adderall for depression. However, Ritalin is an excellent choice for a depressed elderly lady, for the reasons I mentioned above: unlike Lexapro,  Ritalin won’t thin the blood, and it enhances dopamine tone, which is deficient in the elderly.

Stimulants can be a good choice for some depressed young adults, too, for other reasons.

The purpose of this article isn’t to attack stimulants, but to defend them. And to expose how science itself suffers from branding confusion, and how Big Pharma tactics can fudge the scientific name or identity of a drug, to help control a narrative on how the thing is to be used.

Big Pharma views the public mind itself as a market share. And for them, that may mean erasing people’s memory of bothersome scientific facts.