Tianeptine: The Rebel Antidepressant

Tianeptine (brand names: Stablon, Coaxil) is a novel anti-depressant that acts as a Selective Serotonin Reuptake Enhancer, or SSRE.  Unlike SSRIs, it reduces the amount of serotonin in the synaptic cleft, making it essentially the polar opposite of drugs like Prozac and Celexa.

But shouldn’t that make depression worse?

Actually, no.  The idea that depression is caused by low serotonin is nothing more than a marketing ploy created by the proponents of SSRIs; an oversimplified theory in a sea of possibilities.  We all remember this cute Zoloft commercial stating that “depression is caused by a chemical imbalance between nerve cells in the brain”:

In truth, depression is a broad term describing a variety of sometimes contradictory symptoms, such as insomnia/hypersomnia, or reduced appetite/overeating.  Depression comes in many forms, including major, atypical, seasonal, cyclothymic, bipolar and more.  Thus, the causes are as unique as the individual and are not always as simple as a “chemical imbalance”.

By reducing available serotonin in the brain, tianeptine single-handedly disproves the “low-serotonin-causes-depression” theory, which may be part of the reason it’s not being aggressively studied in the U.S.  Just as Xanax treats acute anxiety instantly, tianeptine fights depression symptoms immediately and has promising long-term effects such as improved neuroplasticity and cognition.  By contrast, SSRIs can take up to a month to produce any effect at all.  Tianeptine is generally well-tolerated and can even be used by elderly patients with heart problems, unlike tricyclic antidepressants.  It lacks the sexual side effects of SSRIs and has been available by prescription in Europe and Asia for decades.  It’s currently being studied as a potential treatment for asthma, IBS, fibromyalgia, ADHD and post-traumatic stress disorder (PTSD).

By no means is tianeptine a panacea for depression.  But it raises the question of whether our currently approved meds are monopolizing the depression market and keeping potentially effective drugs out.  If you’ve tried a few SSRIs, you’ve tried them all.  No one is arguing that the current drugs should be phased out–quite the opposite.  More variety simply means more options for patients in desperate need of something that works.

(For everything you ever wanted to know about tianeptine and more, see here).

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2 Responses to Tianeptine: The Rebel Antidepressant

  1. Barry F says:

    Newer research suggests that Tianeptine might exert its effects via dopamine, as well as various other systems.
    I’ve been taking 12.5mg three times daily and I am experiencing sexual side effects. Not the erectile dysfunction or anorgasmia of other anti-depressants, but sexual anhedonia. I can easily maintain an erection and bring myself to orgasm, but it’s more or less only as pleasurable as eating spicy food.
    As you might imagine, the benefit to this is that although I’ve always liked spicy food, I don’t feel the need to factor it in to my plans for the day.

    • neurotruth says:

      Interesting! A 2014 study states that tianeptine acts as an “indirect opioid,” which is also unique.

      I’ve been taking it off and on for about a year with very minor side effects (dry mouth, stomach burning, vivid dreams). Totally acceptable compared to the side effects of other anti-depressants.

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