Tianeptine May Be a Useful Adjunct in the Treatment of Alcohol Dependence of Adolescents

Abstract

Although the mechanisms involved in craving and relapse in alcoholic patients are not known, an effective agent for relapse prevention would have great social and economic benefits. Several studies have reported promising results with opiate antagonists (Mason et al., 1994), acamprosate (Gual andLehert, 2001) and with drugs that affect transmission of serotonin (Naranjo and Kadlee, 1991), and dopamine (Shaw et al., 1994). Tianeptine induces an ex vivo increase of serotonin, uptake by the synaptosomes of the hippocampus and cortex (Mennini and Garattini, 1987). The activity profile and neurochemical characteristics of tianeptine suggest that the drug may be also suitable for use in alcoholic and depressed patients following alcohol withdrawal.We used the Michigan alcoholism screening test (Selzer, 1971) to assess the severity of alcoholism of 26 inpatients without serious coexisting diseases or receiving drugs acting on the central nervous system (after written informed consent). They were 16 -19 years of age, abstinent for at least 5 days before the study, with alcohol dependence of chronic or episodic type (DSM-IV criteria), whose yGT value was at least twice the upper limit of the normal range, and whose mean corpuscular volume was 93 fl or more. They were randomly assigned to tianeptine or placebo, while psychosocial treatment (psychotherapy three times a week, physiotherapy and ergotherapy) was started. Patients received 37.5 mg tianeptine or Placebo daily. They were classified as abstinent or relapsed according to his or her self-report 30 and 90 days after the first administration of tianeptine. We checked the red and white blood count, serum concentrations of sodium, potassium, chloride, calcium, phosphate, blood urea nitrogen, creatinine, uric acid, fasting blood glucose, alkaline phosphatase, total bilirubin, cholesterol, triglycerides, and albumin. There were no initial differences between tianeptine (n ϭ 13) and placebo groups (n ϭ 13) in quantity and frequency of drinking, and Hamilton depression scores.Although our sample of adolescents was relatively small and the time of abstinence was relatively short, our data show, that the proportion of patients who remained abstinent was higher in the tianeptine group than in the placebo group throughout the 90 days of treatment. On day 90, 2 of the placebo-treated patients, compared with 5 tianeptinetreated patients, had been continuously abstinent (MantelCox test; p ϭ 0.0063). Mean cumulative abstinence duration was also significantly greater in the tianeptine group than in the placebo group (69.2 [SD 38.3] vs 31.4 [17.9] days; p ϭ 0.012). There were no remarkable side effects in both groups. Tianeptine had no effect on hematology or serum biochemistry.Our results fit to those of Daoust et al. (1992), reporting a significant decrease of alcohol intake in rats, and Malka et al. (1992), who report good efficacy of tianeptine treating depressive patients after alcohol withdrawal, although the findings of Kranzler and colleagues (Kranzler et al., 1995) dashed ...

Assessment of abuse of tianeptine from a reimbursement database using ‘doctor‐shopping’ as an indicator

“…Because reports of abuse with antidepressants are scarce in the literature and because there was no evidence of such risk on the available data before approval [44], tianeptine was thought to have no abuse potential, as mentioned in the French SPC before 2005. Thus, several authors recommended its use for patients with pre‐existing alcohol‐ or drug‐related disorders [45]. Neurobiological data have shown that the abuse potential of tianeptine may be mediated by mesocorticolimbic dopamine pathway, known to be an important part of the psycho‐stimulant effect of drugs.…”

Practitioner Review: Adolescent alcohol use disorders: assessment and treatment issues

“…In the placebo‐controlled trial, however, there was no difference in the outcomes of the adolescents receiving the SSRI and those receiving placebo. Preliminary support for the efficacy of tianeptine (Niederhofer, Staffen, & Mair, 2003b), which facilitates the re‐uptake of serotonin, and ondansetron (Dawes et al., 2005a, 2005b), a 5HT3 antagonist, have also been reported in adolescents with alcohol use disorders. The relatively modest sizes of these trials, however, prohibit the drawing of definitive conclusions regarding the efficacy of any of these serotonergic medications in adolescents with alcohol use disorders.…”

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