Tianeptine use disorder: a narrative review

Introduction
Tianeptine is an atypical tricyclic antidepressant with a unique, multi-receptor effect increasingly reported as having addictive potential over the past two decades. This narrative review summarises the current knowledge on tianeptine use disorder, including neurobiological mechanisms, clinical presentation, principles of diagnosis and treatment of abuse consequences.

Review of available knowledge
Tianeptine, intro­duced into therapy in the 1980s in France, is currently administered in dozens of countries as an anti­depressant with additional anxiolytic effects. Its activity includes the modulation of the glutamatergic system through the activation of opioid receptors and influence on neuroplasticity. The discovery that tianeptine is an opioid receptor agonist proved crucial to understanding its addictive potential. Abuse of tianeptine was initially observed in the 1990s mainly in European countries and has been on the rise since 2010 in the USA. Those with tianeptine use disorder often have a history of other addictions and mental illnesses. The symptoms of tianeptine intoxication and withdrawal syndrome after discontinuation are similar to those of opioids. The treatment of tianeptine use disorder is analogous to its opioid equivalent: the gold standard is substitution therapy to alleviate withdrawal symptoms and cravings supported by psychotherapy and self-help groups.

Conclusions
Tianeptine use disorder is a problem requiring clinical attention, as are diagnostic vigilance and a multidisciplinary approach to treatment. Due to the limited number of studies, further work is required on optimal detoxification strategies, relapse prevention and monitoring of the impact of legal regulations with respect to tianeptine on public health.