ABSTRACT
BACKGROUND: Tianeptine (Stablon, Coaxil) abuse and dependence has become increasingly prominent worldwide with recent presence in the United States. OBJECTIVE: In this article, we add a case to the growing literature on tianeptine dependence, the first of which is concerning for the presence of an adulterant, and present a comprehensive literature review. METHODS: A literature search was conducted on July 2, 2018 on PubMed for articles using the keywords "tianeptine abuse" and "tianeptine dependence." RESULTS: Literature search resulted in 25 articles and encompassed 65 patients. A majority of patients were male and age ranged from 19 to 67. Routes of intake included oral, intravenous, and insufflation. In the 15 cases of overdose, 8 combined ingestion with at least one other substance, of which 3 resulted in death. Six additional deaths are reported involving tianeptine (9 total). CONCLUSION: Tianeptine abuse and dependence has become a cause for concern in approved markets with recent emergence in the United States. Psychiatrists should be aware of a potentially fatal opiate-like withdrawal in the absence of positive urine drug screens or cases where withdrawal does not follow expected patterns. Tianeptine users should be educated regarding risk associated with this drug. Without further intervention, additional cases should be anticipated.
