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Tianeptine (Stablon°) as an antidepressant: too high a risk of dependence

Tianeptine (Stablon°), marketed as an antidepressant, should be avoided as it carries a high risk of dependence. The risks have been known for a number of years, but health authorities are still ignoring them.

In 2011, France’s national committee on narcotics and psychotropic drugs (CNSP) analysed abuse and dependence data for tianeptine (Stablon°), authorised as an antidepressant. Tianeptine is chemically similar to amineptine (formerly Survector°), which was withdrawn from the market in 1999 for its addictive properties.

Between 2006 and 2010, 45 new cases of tianeptine abuse were reported. Most of these patients were consuming daily doses of 10 or more times the recommended amount, up to 360 to 400 tablets a day, i.e. more than 13 boxes a day in two cases. Of the 23 cases where the patient attempted to reduce or stop taking excessive doses of tianeptine, 13 resulted in hospitalisation. Several patients attempted to quit on numerous occasions, including one patient who was hospitalised 11 times. In 6 cases, the patients were deemed to have been weaned off the drug.

Drawing on figures from France’s national health insurance system, a study was carried out on 3803 patients who had received at least 12 reimbursements for the drug within the same year during the period of the study. 302 of these patients (8%) took  average doses that exceeded the dose specified in the marketing authorisation. 91 patients (2.4%) applied for reimbursement for more than twice the recommended dose. One in every thousand patients applied for reimbursement for very high daily doses of tianeptine.

This adverse effect is unjustifiable, given that tianeptine offers no advantage over many other available antidepressants.

Prescrire has been drawing attention to the danger of dependence with tianeptine since 2000, but in early 2012 patients are still being exposed to this risk.

©Prescrire 1 May 2012

"Tianeptine: more cases of dependence" Prescrire Int 2012; 21 (126): 130. (Pdf, subscribers only).
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