Tianeptine is a type of antidepressant that works differently from most others. Instead of acting mainly on serotonin, it affects glutamate, a brain chemical involved in mood and memory. It also has mild effects on certain opioid receptors, which may add to its mood-lifting and calming effects.
This medication has been used to treat depression, especially when it's linked with anxiety or memory problems. It's also being studied for other conditions like fibromyalgia, bipolar disorder, and depression after quitting alcohol. Even though it's used in some countries, tianeptine is not approved in the United States.
In recent years, tianeptine has been linked to misuse and withdrawal problems, especially when taken in high amounts or in unregulated forms. There have been reports of serious health risks, prompting the FDA to issue safety warnings. Because of this, it should only be used under close medical supervision.
Common indications
Tianeptine may be used for:
- Depression, including types with anxiety or strong sadness
- Depression with memory problems, such as in early Alzheimer’s disease
- As an add-on for bipolar disorder (limited evidence)
- Depression after quitting alcohol
- Some off-label uses being studied, like fibromyalgia and autism
How to take and dosing
Dosing varies depending on the patient's health status, outlined below.
Standard adult dosing
- 12.5 mg, taken three times per day by mouth (total of 37.5 mg/day)
Special groups
- Older adults: Total daily dose should be lowered to 25 mg
- People with kidney problems: Also limited to 25 mg per day
- Liver problems: Liver function should be watched; there are reports of liver injury
Tianeptine works quickly in the body and has high absorption. Stopping it suddenly is not advised.
Side effects
The most common side effects of tianeptine include upset stomach, dizziness, headache, dry mouth, constipation or stomach pain.
More serious side effects of taking this medications are:
- Confusion or feeling very sleepy
- Fast heartbeat or changes in blood pressure
- Vomiting or strong stomach pain
- Mood changes or signs of withdrawal
You should inform your doctor of any new side effects or reactions that you note after starting a new medication.
Contraindications for use
The medication should not be taken by:
- People taking MAOIs (need a 2-week break before starting)
- Pregnant or breastfeeding individuals
- Children under 15
- Anyone allergic to tianeptine or its ingredients
Heart tests may be needed in older adults or those with heart issues. Ongoing checkups are helpful during treatment.
Abuse potential and withdrawal
Tianeptine’s mild opioid effects can lead to misuse or addiction, especially in large doses. Some people have experienced withdrawal symptoms like nervousness, stomach upset, and shaking when stopping the drug.
Naloxone has been used to treat overdoses. Because of its risks, several US states have restricted or banned tianeptine even though it’s not FDA-approved.
Regulatory status in the US
Tianeptine is not approved by the FDA for any medical use. The FDA has warned that products containing it—often sold as supplements—can be dangerous and have led to overdoses and deaths.