Gas station heroin – harmful use of tianeptine based on a case report

Tianeptine is a unique antidepressant with a distinctive mechanism of action. The distinctive effects of tianeptine result from its enhancement of serotonin reuptake, modulation of the glutamatergic system, and promotion of neuroplasticity, as well as its affinity for the µ-opioid receptor. For many years, tianeptine was considered a drug with low addictive potential; however, new reports describing its interaction with the µ-opioid receptor suggest a significant risk of physical dependence, particularly in patients using doses that exceed medical recommendations. Reports of patients abusing the drug and experiencing withdrawal symptoms during dose reduction have become increasingly common. The legal status of tianeptine worldwide remains ambiguous – in some countries, it is not registered as a medication. There is also a growing number of warnings regarding its improper use. In the presented case, a patient initially responded well to the treatment; however, the effect quickly diminished, leading the patient to take doses far exceeding medical recommendations. Attempts to discontinue the drug were associated with severe withdrawal symptoms. In clinical practice, when treating patients with tianeptine, psychoeducation regarding the risk of substance misuse and a thorough medical history are essential.