Efectividad de tianeptina en pacientescon depresión mayor y trastorno poruso de sustancias / Effectiveness of tianeptine in patients with major depressive disorder and substance use disorder

Introducción: La depresión coexiste frecuentemente conlos trastornos por uso de sustancias (TUS), lo que conllevaun peor pronóstico. Existe una importante falta de evidenciasobre las intervenciones terapéuticas más efectivas para estacomorbilidad. Los estudios existentes sugieren que los antidepresivos disponibles actualmente son poco eficaces paraestos pacientes. La disponibilidad terapéutica de antidepresivos con mecanismos neurobiológicos diferentes podría seruna alternativa. El objetivo es describir la evolución de ungrupo de pacientes con esta comorbilidad que han realizadotratamiento con tianeptina en condiciones de práctica clínica habitual en consultas de deshabituación.Metodología. Se diseñó un estudio postautorización,multicéntrico, retrospectivo y observacional de práctica clínica habitual. Se revisaron las historias clínicas de los 100últimos pacientes diagnosticados de depresión mayor y TUS,tratados con tianeptina durante al menos 3 meses. Se evaluaron en tres ocasiones (inicial, intermedia y final a los 3meses) las siguientes escalas: Escala de Evaluación para laDepresión de Hamilton (HDRS), Escala de Impresión ClínicaGlobal (ICG) y Escala de Gravedad de la Adicción (SDS).Resultados. La mayoría de los pacientes fueron tratadoscon una combinación de psicofármacos y psicoterapia. Alfinal del seguimiento 70 pacientes (70 %) obtuvieron unaremisión clínica según la escala HDRS y 76 pacientes (76 %)se clasificaron con mucha o moderada mejoría según ICG.Respecto al consumo, los descensos más destacados se produjeron en los trastornos por uso de alcohol y cocaína.Conclusión. Tianeptina, en monoterapia o en combinación, puede ser un tratamiento de utilidad para pacientescon depresión dual de forma conjunta con otras medidasterapéuticas que traten de forma integrada estos pacientescomplejos. (AU)

Introduction: The depressive disorder coexists in a highprevalence with a substance-related disorder, which is associated with a worst prognosis. The therapeutic interventions for this co-morbidity lack of the appropriate scientificsupport. The existing evidence suggest that the currentlyavailable anti-depressive drugs are of minor efficacy in thisgroup of patients. An alternative would be the use of different drugs with distinctive neurobiological mechanismof action. The aim of this study was to describe the clinicaldevelopment of a series of patients affected by this comorbidity under treatment with tianeptine under usual clinicalpractices.Methods. Study design corresponds to a post-authorization, observational, retrospective, multicentric, study underusual clinical practice study. The clinical history of the lastconsecutive 100 patients diagnosed of major depressive andsubstance-related disorders under treatment with tianeptinefor at least 3 months was reviewed. The following scales wereevaluated in 3 times (basal, intermediate, final): HDRS, ICGand SDS. Results. Most patients were treated by a combinationof anti-depressive drugs together with psychotherapy. Atthe end of follow-up, 70 % patients had a clinical remissionin accordance with HDRS and 76 % of them had a mild orsignificant improvement in ICG. Regarding the use of substances, the most remarkable decreases were obtained in theconsumption of alcohol, and cocaine.Conclusion. Tianeptine could be a useful drug for thetreatment of patients with dual diagnosis of depression andsubstance-related disorder, together with other therapeuticinterventions. (AU)

Tianeptine, an atypical pharmacological approach to depression. / Tianeptina, un abordaje farmacológico atípico de la depresión.

The introduction of the first antidepressants in the 50s of the 20th century radically changed the treatment of depression, while providing information on pathophysiological aspects of this disease. New antidepressants drugs (agomelatine, tianeptine, vortioxetine) are providing data that give rise to pathophysiological hypotheses of depression that differ from the classic monoaminergic theory. In this sense, tianeptina, an atypical drug by its mechanism of differential action, contributes to clarify that in depression there is more than monoamines. Thus, tianeptine does not modify the rate of extracellular serotonin, so it does not increase or decrease the reuptake of serotonin. Chronic administration of tianeptine does not alter the density or affinity of more than a hundred classical receptors related to depression. Recently, a weak action of tianeptine on Mu opioid receptors has been described that could explain the release of dopamine in the limbic system and its participation in the modulation of glutamatergic mechanisms. These mechanisms support the hypothesis of the possible mechanism of action of this antidepressant. Tianeptine is an antidepressant, with anxiolytic properties, that can improve somatic symptoms. Tianeptine as a glutamatergic modulator, among other mechanisms, allows us to approach depression from a different point of view than other antidepressants.