Tianeptine Abuse and Dependence in Psychiatric Patients: A Review of 18 Case Reports in the Literature

Abstract

Tianeptine is an atypical antidepressant approved in 25 countries for the treatment of depressive syndromes. Tianeptine abuse among psychiatric patients in the community and at inpatient wards has been increasingly reported in recent years. The purpose of this article is to alert clinicians to tianeptine abuse potential and identify any patterns in the literature. We searched the Academic Search Complete, Google Scholar, MEDLINE, Science Citation Index, Scopus, and the Social Sciences Citation Index for articles published between 1960-2017 in any language containing the keywords: "tianeptine abuse," "tianeptine misuse," "tianeptine dependence." The search retrieved 18 cases. Higher frequency of tianeptine abuse/dependence was observed in women and 30- to 45-year-olds. Most cases (n = 13) reported a previous history of substance abuse. The therapeutic dose of tianeptine was exceeded 110-fold (i.e., up to 4125 mg/day) with a mean of about 1469 mg/day. The most prominent phenomena associated with tianeptine abuse and dependence were marked euphoria and withdrawal symptoms perpetuating further drug misuse. Tianeptine is a drug with potential for abuse and addiction. Caution should be taken when considering the prescription of tianeptine to patients with prior history of substance abuse, and close monitoring for drug misuse is needed during the treatment period.

Tianeptine Esters Derivatives: A Study of Protein-Drug Interaction Performed by Fluorescence Quenching and Molecular Docking

“…2 Later, it was shown that tianeptine also modulates the glutamatergic system, showing effects on neuroplasticity in the hippocampus and amygdala. 3,4 In 2014, it was shown that tianeptine interacts with the opioid receptors µ and d. 5 Interaction with µ-receptors could explain the dependence issue in high doses, 6 while interaction with d-receptor could explain the antidepressant properties. 7 Tianeptine has a lateral amino acid chain that is directly associated with the pharmacological properties of the drug.…”

Excessive consumption of tianeptine by a person with former alcohol problem

“…Also, intensified anxiety was present before alcohol problems began. These elements make tianeptine dependence diagnosis doubtful and indicate rather a personality predisposition to substance misuse, than a special addictive mechanism of tianeptine itself, as suggested in other publications 5,6 .…”

Use of Buprenorphine-Naloxone in the Treatment of Tianeptine Use Disorder

“…Cases of intentional misuse have been documented going back as early as the 1990s in Europe (Vandel et al, 1999). Though typically prescribed at 12.5 mg 3 times daily, intentional misuse has been documented with doses ranging from 1500 mg to more than 4000 mg daily (Saatcioqui et al, 2006;Springer and Cubala, 2018). Intravenous use, with associated complications, has been reported (Vadachkoria et al, 2009;Ihan et al, 2013;Dempsey et al, 2017).…”