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Health

Do You Want to Be Sad, or Skinny? The Slippery Solution of Wellbutrin

The internet is full of soft chatter about the weight loss effects of an antidepressant not recommended for those with eating disorders—but that gets prescribed to them anyway.
June 14, 2021, 11:00am

In February 2020, a Twitter user named @gracecamille_ started a thread about choosing an antidepressant. “Hey girls what is an antidepressant that has made u lose weight?” she wrote. “if i’m going to have the libido and mental function of a sea sponge I might as well get skinny.”

A little more than a year later, the tweet has over 100,000 likes, 7,000 retweets, and 750 responses. Among the replies was a litany of praise for Wellbutrin, one of the only antidepressants that typically causes weight loss and increases libido. Twitter is, in fact, brimming with recommendations for the drug, but the glowing reviews are more for its weight loss effects than its antidepressant ones. In March of 2020, @HaileyBeluga wrote, “starting back on wellbutrin today so let’s hope it makes me horny or skinny or both. maybe less depressed, too.” One Tumblr user posted about manipulating a doctor into prescribing her Wellbutrin, which she planned to use for weight loss.

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In online forums, and on Twitter and on Tumblr, young people trade tongue-in-cheek death wishes and diet tips. There’s a Tumblr called “Live Fast Die Young Sad Girls Do It Wellbutrin” and another one titled “Wellbutrin Dreams,” which has the phrase “I’m only pretty when I’m medicated” displayed prominently on its homepage. Sierra (who requested anonymity to protect sensitive medical information), a 22-year-old who began taking Wellbutrin during her first year of college, described TikTok as a common place for people to hear about Wellbutrin as “the skinny horny zoom zoom antidepressant.” Dasha Nekrasova, host of the cultural commentary podcast Red Scare, has a Twitter account, separate from her main account, called @dash_eats, where she posts about both what she eats and her physical appearance, sometimes including her exact weight in pounds. She called herself a “wellbutrin success case” in an Interview feature last year titled “Dasha Nekrasova Believes in God, Sigmund Freud, and Wellbutrin,” and in an April 2020 podcast interview, Nekrasova cited a desire not to gain weight as part of what drove her towards Wellbutrin, instead of traditional SSRI formulations.

Online, those in search of an antidepressant that leads to weight loss recount stories of pliant psychiatrists prescribing Wellbutrin, despite the explicit FDA warning that patients who “have or had an eating disorder” at any point in their life should not take the drug. Wellbutrin can cause seizures, and a patient’s risk of experiencing one on the drug is extremely heightened if they purge or are malnourished—a side effect documented in studies as early as 1988 and as recently as 2018. Wellbutrin is also contraindicated with eating disorders—medical terminology for “prescribe with caution”—due to its reported risk of triggering a relapse in recovered patients, as unintentional weight loss is a common precursor to eating disorder relapses. Still, over the years, sales representatives for the pharmaceutical company GlaxoSmithKline—which did not respond to multiple requests for comment for this story—cast Wellbutrin as the “happy, horny, skinny pill,” highlighting its use for weight loss and sexual dysfunction, though it had not been approved as a treatment for anything but depression.

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I first heard about Wellbutrin from a friend. It was 2016, my senior year of college, and we were in the bathroom of my apartment, getting ready to go out. Everything in there was greenish beige, tiles and stall doors and dirty sinks—the perfect setting for a before shot in an antidepressant ad. But we were loud, laughing over the music floating out of an open bedroom door. I commented on how thin she’d been looking lately, and she shrugged and told me, “It’s the Wellbutrin.” Her psychiatrist had suggested a new antidepressant, one with a stimulant effect that might also heighten her sex drive. Days after she started taking it, she was bouncing out of bed, and blacking out even faster. She said the drug got her drunk fast, but by the time she remembered to only have two drinks, she’d already had three. The only annoying thing about it, she said, was that she wasn’t hungry. 

She suggested I ask my psychiatrist about it. She knew I had recently stopped taking an SSRI, and that I was frustrated by my low sex drive and terrified of extra pounds. She didn’t know about the eating disorder I’d had in high school. A couple hours later, tipsy in a different bathroom, I googled ‘wellbutrin weight loss libido’ on my phone. The first result was a Harper’s Bazaar article titled “The Happy, Sexy, Skinny Pill?” I clicked. The page loaded to a closeup of a woman’s face. Her skin is pale and poreless. Her expression is pleasure gone plastic, eyes closed and mouth open, painted with pinup makeup, red lips and a shimmering smokey eye. Visible against the black void of her open mouth is a small mound of pink tongue playing pillow to a heart-shaped pill. 

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The article outlines one woman’s Wellbutrin journey, which began when she went to her doctor “seeking an antidepressant but with two firm deal breakers: I wouldn’t take any drug that would make me gain weight or one that would make sex more problematic.” At the time, I was more allured by the heightened metabolism the woman wrote about having on Wellbutrin than any improvement in her mental state, and like many girls googling weight loss, imagined the latter would probably improve if I could lose some weight. Back then, I felt like I’d located my spirit guide through the confusing world of psychopharmaceuticals. Rereading the article now, I am disturbed by the way the author positions her priorities, the way any weight gain caused is automatically assumed antithetical to her happiness. I am terrified for that drunk girl in the bathroom, about to follow a wolf in hot girl’s clothing right off a cliff. 

Back in my dorm room that night, I turned to the real experts, at least in my opinion: the girls on Tumblr and in eating disorder forums who had never lied to me before, the girls I’d turned to when I first fostered an eating disorder in middle school. They reported better moods and lower weights on Wellbutrin, though it wasn’t clear which caused the other. One wrote that “The ‘wellbutrin effect’ (whether it is appetite suppression, hyperness, or just generally happier so not emotionally eating all day) is still working for me.” Another wrote that they told their psychiatrist “to switch me to Wellbutrin since I read enough medical articles to know that an SSRI is well known for contributing to weight gain.” “Another pro for Wellbutrin...increased sex drive...looks like a win-win for my husband. Happier, thinner, hornier wife,” said a third. 

I was sold. On one of the last days of my senior year, I searched the therapist listings on Psychology Today, looking for a youngish woman on the Upper East Side. I thought a woman would be most understanding about my aversion to weight gain, and after reading the stories of a few online bloggers who had successfully procured Adderall prescriptions, figured one who worked in a fancy uptown zip code would be interested in pleasing customers, and lax with her prescription pad. A week after graduation, I had three prescriptions waiting for me after one visit with a psychiatrist: Wellbutrin, Xanax, and Trazodone. Crinkly CVS bag in hand, I couldn’t believe how easy it had been. 

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I’d read on the forums that some doctors refuse to prescribe Wellbutrin to recovered eating disorder patients, which was what I thought I was, but most of the women online seemed able to get the drug with enough perseverance. I expected a little resistance; what I got was extra drugs. Because Wellbutrin is also a stimulant, my new psychiatrist worried it would interact poorly with my anxiety, maybe heightening panic or making my intrusive, circular thoughts spin faster, so she prescribed Xanax for those moments. She also worried about my sleep schedule on a stimulant, so she prescribed me a sleeping pill called Trazodone, which I didn’t realize was originally formulated as an antidepressant until months later.

Mental health is a medical issue, but it is also a rhetorical one. Unlike almost any other bodily problem, the primary way to convey symptoms of mental health issues to a doctor is through words and descriptions. There’s no brain scan that reveals tell-tale, disobedient synapses refusing to fire, no blood test that betrays elevated levels of misery or mania. Emotional illnesses are necessarily narrative, and this dynamic works in the opposite direction too, before the patient becomes a patient, when they are merely a person feeling bad. 

That patients can now research a drug’s side effects before meeting a doctor allows them far more agency over their psychiatric care. But while women and femme presenting people may now have more say in what psychiatric medication they take, far more women than men are still being medicated psychiatrically, a fact reinforced by the way women are presented as the protagonists of most antidepressant advertisements. A 2011 study on prescription drug use in the first decade of the 21st century found that one in four women took prescription drugs for a psychological condition and that antidepressant use among women increased almost 30 percent over the course of the decade. As of 2017, according to the American Psychological Association, women are two and a half times more likely to be prescribed antidepressants than men, and this disparity appears in the data right when puberty does, around age 11. 

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In the U.S., where diet culture is omnipresent, an 11 year old girl may be about to embark on her first psychopharmacological journey, and she might also have already been on her first diet, as 25 percent of American girls have by age seven—a fact that is disturbing even without the related and alarming fact that studies have shown that 20 to 25 percent of dieters eventually suffer from eating disorders. If that child also spends time on TikTok, where influencers post “what I eat in a day” videos and high schoolers in their bedrooms make videos about losing their appetite on Wellbutrin, they may ask their psychiatrist about Wellbutrin, and end up popping a pill that enables a nascent eating disorder. 

As someone who has been one of these girls, I remember that mindset, the way an eating disorder warps your logic, transforming thinness into an ideal to be achieved at any cost, one with a mirage as a goalpost, dissipating ever further into the distance as you approach it.

A person feeling bad is often in search of a story they can slot themselves into, one easier to explain to a doctor than a nebulous array of symptoms. The psychopharmaceutical industry knows this, so they offer people storylines in advertisements, selling narratives that feature images of women gazing sadly out windows or fidgeting anxiously with a broom in hand, a phenomenon that is unsurprising in light of the medical industry’s long history of overmedicating women, from prescribing opium to Victorian women and girls deemed ‘hysterical,’ to tranquilizing 60s housewives beset by boredom. Early advertisements for psychiatric medications often used female pronouns, selling drugs with taglines like “now she can make breakfast again” and “her kind of pressures last all day...shouldn’t her tranquilizer?”  

A 2004 Wellbutrin ad, published in the wake of a 2002 study that found statistically significant rates of weight loss associated with Wellbutrin, directly targeted patients already on traditional antidepressants who might be dissatisfied by their current side effects like weight gain and dampened libido. The ad depicts a woman laughing in the center of the frame, as a man (presumably her romantic partner) paddles the two of them across a lake in a canoe. The sun is shining, and the text reads: “Wellbutrin XL works for my depression with a low risk of weight gain and sexual side effects. Can your medicine do all that? Experience Life.” Another advertisement shows a woman’s face in the foreground, eyes closed and teeth bared in a wide smile, as a man with most of his face hidden whispers something in her ear. In the world of these ads, a full life is a skinny, heteronormal one. 

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Wellbutrin first hit the U.S. market in 1989 as a treatment for major depressive disorder. It’s the brand name of a drug called amfebutamone—later renamed bupropion—that was patented in 1974 by the British pharmaceutical company Burroughs Wellcome. According to the Journal of Clinical Psychiatry, the drug came out of a program seeking to formulate an antidepressant with “tolerability advantages” over existing SSRI formulations, which means a drug with fewer side effects.

Since their initial approval in the late 1980s, SSRIs like Prozac and Zoloft have been the most common form of antidepressants prescribed in the United States. But while these drugs—which work by blocking serotonin reuptake transmitters, allowing the chemical to remain active in the brain longer—may have made patients happier, they also made them heavier. According to the Journal of Clinical Psychiatry, SSRIs are often associated with weight gain, and Psychology Today has reported on patients experiencing weight gain of up to 40 pounds. For many people suffering from depression, SSRIs vastly improve quality of life, and accompanying weight gain is a side effect they can live with. But a subset of patients found the fog lifted, their vision clarified, and the reflection in the mirror suddenly disturbing. The topic did not go unnoticed: Harvard Medical School’s Women’s Mental Health Resource site has a devoted subpage for Antidepressants and Weight Gain, and a 2014 Atlantic article investigated “The Depression-Weight Gain Cycle.”

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Once studies found that patients were not only not gaining weight, but often losing it on Wellbutrin, the drug seemed to offer a psychiatric solution for patients whose main complaint about antidepressants was the associated weight gain. The pharmaceutical companies appeared to have a moneymaker on their hands, until a rare side effect started occurring in higher than expected numbers. Soon after its release, patients who took Wellbutrin began ending up in emergency rooms, following seizures. Wellbutrin was removed from the market between 1986 and 1989 as its manufacturers worked on a formulation that delivered the dose over the course of the day, rather than all at once, somewhat reducing the seizure rate. The prevalence of seizures was too high in general but especially high in women with eating disorders. A 1989 trial found that one in 200 patients taking the then-target dose of 450 milligrams experienced a grand mal seizure.

A separate study looked specifically at bupropion and bulimia, while others began studying bupropion and anorexia. The drug had at first seemed like a perfect fit for eating disorder patients, often co-diagnosed with depression or anxiety but resistant to SSRIs due to the specter of weight gain. Those struggling with bulimia specifically were considered ideal candidates for Wellbutrin, as doctors hypothesized that the drug’s correlation with weight loss might indicate it could prevent binge eating. A 1988 study that treated bulimia with bupropion found that hypothesis about binge eating to bear out, but also discovered terrifying side effect statistics: the drug successfully reduced binge episodes, but 7 percent of patients had seizures.

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In 2003, GlaxoSmithKline (which had purchased Burroughs Wellcome) released a new once-daily, extended-release capsule with a maximum dose instituted to prevent seizures. The manufacturer began noting that the drug was contraindicated with eating disorders. Still, by 2007, Wellbutrin was the 29th most prescribed medication in the United States, prescribed almost 20 million times that year. 

In 2012, GlaxoSmithKline pleaded guilty to illegally marketing Wellbutrin as a drug that could spur weight loss and libido. The lawsuit brought by the U.S. government alleged that GSK hired public relations firms to encourage off-label use, the official term for prescribing a drug for something it is not approved by the FDA to treat. The suit also alleged GSK had a pattern of paying doctors and hosting supposedly “independent” medical events promoting the drug. Also that year, Forbes reported that Dr. Drew Pinksy was alleged to have been paid to promote Wellbutrin for its off-label uses for weight loss and sexual dysfunction; the report stated that he received $275,000 in advance of media appearances that included a radio show in which a woman on Wellbutrin recounted coming 60 times in one night. (Pinsky told Forbes his comments were “consistent with [his] clinical experience.”) According to government regulators, an internal GSK memo reported that 387 million people had seen some form of media touting Wellbutrin as a drug for “weight loss and sexual dysfunction,” a “happy, horny, skinny” pill by the end of the campaign in the early 2010s. 

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GSK was fined $3 billion for the unlawful promotion of Wellbutrin and several other drugs, among other complaints against them. It might have considered that the cost of doing business, and a reasonable one at that: by 2017, the drug had moved up six places in the rankings. It was prescribed 24.9 million times that year. As of the last published rankings in 2018, it is the 27th most prescribed psychoactive drug in the U.S. 

Ainsling Berrios, 18, said her doctor put her on Wellbutrin when she was in 9th grade. “I was never told anything regarding the fact that it is not supposed to be prescribed to people who have or are at risk for eating disorders,” she told VICE. “I was a 155-pound, five-foot girl, so I guess he didn’t really see me as anyone who might have an eating disorder.” The Diagnostic and Statistical Manual of Mental Disorders, the standard text for mental health professionals, classifies eating disorders as mental illnesses, which anyone can have at any weight. Asking patients whether they abuse alcohol or drugs before prescribing them psychiatric medications is a regular practice at psychiatrist offices. But the patients I spoke to said their doctors did not ask about eating disorders.

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Once her doctor prescribed the drug, Berrios told VICE that she did some research, found out about its weight loss side effects, and “used it to fuel my eating disorder.” She said she lost 30 pounds in a single month. Sierra said, “I became obsessed [with taking Wellbutrin]” and “found myself super deep into subreddits about eating disorder recovery talking about how Wellbutrin made them lose weight.”

Anniston Moore, 22, said her psychiatrist introduced her to the drug in 2019 and did not tell her about its contraindication with eating disorders. “I’m overweight, so I’m not sure he was worried about me having an ED,” Moore told VICE. Like me, Rachel Burns, 20, first heard about Wellbutrin from a friend, one who had wanted to switch to the drug because she heard about its supposed weight-loss benefits. ”My doctor did not mention anything about eating disorders,” Burns told VICE, though she said she hadn’t disclosed her eating disorder to him. “I have a ‘normal’ BMI, so I physically didn’t look sick.” She described her year-and-a-half on Wellbutrin as a “rollercoaster.” 

After starting Wellbutrin, Burns initially lost weight, and began losing more once her doctor prescribed a combination of Wellbutrin, which works on norepinephrine and dopamine, and a traditional SSRI, which work by increasing the concentration of serotonin in the brain. The drug-induced weight loss, she said, “made my eating disorder worse because I felt motivated.” 

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Lia (who requested anonymity due to her sharing medical information), 24, heard about Wellbutrin from a doctor in 2014 but said he mentioned nothing about its potential effect on patients with eating disorders. “He said it would help me lose weight because at the time I was super fat,” she told VICE. She later struggled with heightened eating disorder symptoms while taking the drug. “It definitely gave me more energy and lessened my sensory sensitivity,” she said. “But it also contributed to an eating disorder relapse, ’cause I started taking it and lost 10 pounds and then was like, ‘I must lose more.’” 

On the Working Towards Recovery forum on NationalEatingDisorders.org, one user started a thread titled “Wellbutrin XL and eating problems,” where the first post reads: “I’m on Wellbutrin XL and if I don’t take it, I get anxious because I actually feel hunger without it. I am afraid to stop taking it but it feeds into my restricting,” the user wrote. “I feel trapped.” Tumblr and Reddit users post about similar struggles with the drug. On Reddit, in the EDAnonymous forum, there are threads like “i miss my skinny pills” and “somehow managed to get myself wellbutrin without even trying” where people wax nostalgic for “skinny me” on Wellbutrin and describe doctors who prescribed them the drug without discussing their patient’s eating disorder history. One anonymous Reddit user wrote about seeing a psychiatrist after being hospitalized for self-harm and receiving Wellbutrin she knew would enable her eating disorder: “maybe this’ll give me extra skinni and give me back my will to live.” 

Some people posting about Wellbutrin on these sites will cite reports that it’s dangerous if taken while restricting food and consuming alcohol. Some tweet about the seizure risk, but they write in an irony-soaked tone that approaches the issue as more of a vague bummer in the final calculus than a dealbreaker. A Twitter user named @reemsworld wrote, “Wellbutrin gave me a seizure so like, pinch of salt ya know.” Another online poster, on Tumblr, recognized that the drug could cause an eating disorder relapse and wrote about considering taking it anyway. They wrote about going through an inpatient eating disorder clinic, only for their doctor to “fuck up. He prescribed me Wellbutrin XL...Major side effect of Wellbutrin - NO APPETITE...Time for a relapse?” 

As someone who has been one of these girls, I remember that mindset, the way an eating disorder warps your logic, transforming thinness into an ideal to be achieved at any cost, one with a mirage as a goalpost, dissipating ever further into the distance as you approach it. Eating disorders are competitive and irrational illnesses that skew priorities as much as self-image, fostering thought patterns that are all too easy to fall back into, ones I have found myself slipping towards when I scroll the Wellbutrin tag on Twitter for too long. In most of their posts, the writers relish or yearn for Wellbutrin’s ability to suppress appetite and spur weight loss, and seem to consider its potential antidepressant effects a possible nice side effect, not the ultimate goal. 

But that’s an outsider’s reading. Inside the wind tunnel of an eating disorder, you feel as though the antidepressant effect comes from being thin, that the two are inextricable. On Wellbutrin, I marveled at how much food I could leave on a plate without the old ravenousness clawing at my stomach, and I marveled at myself in windows on the street. I used my body on Wellbutrin as a battering ram against my self-loathing and sadness—distracting myself from reflective moments with reflective surfaces.

According to Dr. Frank Greenway, a researcher at Penn Biomedical Center who has studied Wellbutrin’s potential as a weight-loss drug for obese patients, medicine has moved away from a paternalistic model where the doctor is considered the unequivocal expert on the patient, and towards a model where decisions around medications are made through a dialog between both parties.

“This model requires that the patient be open with the physician and the physician be open with the patient,” Greenway said via email. “If either of the parties are not open with each other, it compromises the quality of the medical care.” He emphasized that “since there are more contraindications or warnings that may apply to diseases that from the medical history and physical exam the patient does not have, those diseases understandably might not be discussed in the conversation leading to the choice of a therapy.” 

Greenway added that a patient who does not disclose an eating disorder should not assume their doctor will alert them if a medication is not meant to be taken by someone suffering from disordered eating. On the other hand, it is common practice for doctors to ask patients if they have contraindicated conditions when prescribing medicines—for example, if a drug is not recommended for people with high blood pressure, or diabetics, doctors often ask patients if they have these conditions, rather than assuming they would disclose them first. The assumption that patients will disclose a mental health condition, and that they are doing their own research, can end up enabling people with eating disorders who are hoping to lose unhealthy amounts of weight, whatever the cost.

This turn away from paternalism and toward open doctor-patient communication seems at first like a road toward reversing the Western history of overmedicating women. Yet it finds itself up against an overworked medical system in which doctors can easily neglect the prevalence of eating disorders in young patients growing up in a country where unattainable beauty standards are deeply entrenched. The questions doctors ask—or don’t ask—in the precious span of time before anything is written on a prescription pad have consequences, and for many vulnerable young people, the current model is sending them down the rabbit hole, and onto the internet.

While taking Wellbutrin, I relapsed into the eating disorder I thought I’d recovered from in high school. Eighteen months into my time on the drug, one Sunday morning, hungover at a friend’s apartment, I blacked out in the middle of a sentence, and woke up surrounded by EMTs and my terrified friends, who informed me I had had a seizure. In the hospital, when the doctor asked me if any of my prescriptions had changed recently, I told him that I had just gone up to 450 milligrams of Wellbutrin and he looked me up and down with raised eyebrows, shaking his head. He told me that’s a high dose for a man, sometimes called the ‘seizure dose’ for women by doctors, in private. He couldn’t believe it had been prescribed to someone my size. 

I stopped taking Wellbutrin and seeing that psychiatrist. I blamed them to anyone who would listen, and blamed my disordered eating on myself. I didn’t think of myself as a victim of a grand conspiracy by the capitalist pharmaceutical patriarchy, or even as a collateral casualty of a well-intentioned capitalist pharmaceutical patriarchy. I went off antidepressants completely, and suffered withdrawal symptoms and relapses of other mental health issues, which eventually led to new prescriptions. The friend who introduced me to Wellbutrin doesn’t take it anymore either, and sometimes we talk about our time on it, laughing nervously, hiding the wistfulness we can’t completely shake. I want to be above that, a woman who loves all types of bodies, even my own, and hope I will become her one day. But I don’t blame myself anymore. 

The history of women and their psychiatrists is long, and when I accept my membership in the sorority of patients, I watch my adolescent body get thrown like a pebble into a pond, surrounded by green fields of money. I see magazines filled with waifish models and antidepressant ads I flipped past on my childhood bedroom floor. I see the Instagram ads that still pop up on my feed, offering me mental health quizzes and ‘meditation for women’ apps and Gwyneth Paltrow’s Netflix show and diet tea. I see the eating disorder memes and weight loss progress Instagram accounts and slim, smiling influencers, and wonder how I could have ended up anywhere but at the bottom of the lake.  

Follow Emmeline Clein on Twitter.