The unapproved antidepressant that's poisoning people

From 2014 through 2017, there was an increase in US poison control calls related to the intentional abuse an...

Posted: Aug 4, 2018 10:34 AM
Updated: Aug 4, 2018 10:34 AM

From 2014 through 2017, there was an increase in US poison control calls related to the intentional abuse and misuse of tianeptine, an unapproved antidepressant drug, the US Centers for Disease Control and Prevention said in a report on Thursday.

Tianeptine, marketed as Coaxil or Stablon, is used as a prescription antidepressant in Europe, Asia and Latin America. In the US, it can be purchased on the Internet, even though the US Food and Drug Administration has not approved its use.

Behavior and cognition

Business and industry sectors

Business, economy and trade

Centers for Disease Control and Prevention

Continents and regions

Diseases and disorders

Drug safety

Drug safety, efficacy and availability

Government organizations - US

Health and medical

Intelligence and cognition

North America

Pharmaceutical industry

Pharmaceuticals and biotechnology

Pharmaceuticals and prescription drugs

Poisonings

Public health

Science

The Americas

United States

US Department of Health and Human Services

US federal departments and agencies

Antidepressants

Controlled substances

Drugs and society

Epidemics and outbreaks

Opioid epidemic

Opioids

Prescription drug abuse

Society

Substance abuse

There have been reports that recreational abuse might result in severe side effects including vomiting, confusion, coma and kidney failure. The drug can be lethal in rare cases.

"Deaths associated with misuse of tianeptine have been reported outside the United States," CDC researchers wrote in the new report. They added that two recent deaths attributed to "tianeptine toxicity" occurred in the US after the drug was purchased online.

Opioid connection

Discovered and patented by The French Society of Medical Research in the 1960s, the drug has shown beneficial effects against some symptoms of depression, including anxiety. Yet when it was first developed, its precise mode of action was unclear.

Research published in 2014 revealed that the drug stimulates some opioid receptors, which in turn release the brain's chemical messengers (neurotransmitters), and this change in brain chemistry provides relief for some people with depression. Even before that study, though, reports of tianeptine abuse and withdrawal were similar to those of opioid abuse and withdrawal.

"In light of the ongoing U.S. opioid epidemic, any emerging trends in drugs with opioid-like effects raise concerns about potential abuse and public health safety," CDC researchers wrote.

For the new study, the CDC analyzed all calls related to tianeptine reported by poison control centers to the National Poison Data System during 2000 through 2017 to better understand the frequency of tianeptine abuse and common complaints.

The researchers found an increase in calls related to tianeptine use. More than 80% of the calls were about men. The total number of poison control calls increased from just five in 2014 to 38 in 2015, 83 in 2016 and 81 in 2017. About a third of the calls came from the South, and the average age was 35 years, according to the CDC. More than 90% of the calls came from health care providers.

Moderate negative effects including neurologic (confusion), cardiovascular (tachycardia) and gastrointestinal signs and symptoms (nausea and vomiting) were commonly reported to poison control centers. Slightly fewer than half the calls reported co-exposures to other drugs, including benzodiazepines, which have sedative effects, and opioids, which have pain-relieving and euphoric effects, according to the CDC researchers. Poison control centers reported 29 withdrawal-associated calls. No deaths were reported.

"Tianeptine has an abuse potential in former opiate drug users," the CDC researchers concluded. "This study further highlights that the withdrawal effects of tianeptine mimic those of opioid withdrawal."

In a recently published case study, co-author Dr. Raphael Leo, an associate professor in the Department of Psychiatry at the University of Buffalo, characterized the unapproved antidepressant as "available in tablet capsule, and powder form and ... accessible from online commercial sources under the rubric of nootropics."

Nootropics, sometimes referred to as "smart drugs," include a range of natural supplements and prescription drugs that some believe boost cognitive effects, including attention and creativity.

The case study describes how a 42-year-old man was found unresponsive by his wife after his use of tianeptine. In the ambulance, he was given naloxone, which revived him, and after admission to the hospital, he was given fluids and supportive care. He reported taking tianeptine for chronic back pain and "acknowledged using more than he customarily would," wrote Leo, who was not involved in the CDC study.

Ultimately, the patient recovered and was discharged from the hospital.

Leo told CNN that dosage creep -- taking more of a drug over time to achieve its beneficial effects -- might be a problem when patients self-medicate with substances sold online.

Self-medicating for 'mood and cognitive function'

Blogs advocate use of amounts far greater than the recommended daily antidepressant dose to achieve "opioid-like effects," Leo wrote in his published case study. "Anecdotal reports from internet blogs seem to suggest that higher doses are necessary to acquire euphoric effects over time, as illustrated in this case."

As for the CDC findings, Leo said he had "anticipated an increase" in tianeptine as well as "related compounds" billed as nootropics found online.

"I think people have this misguided belief that if you can get it on the internet and it's not overtly illegal and you're not going through the dark web to acquire these substances, so it must be OK," Leo said.

Some people who seek out tianeptine are searching for "a supplement to enhance mood and cognitive function," Leo said, adding that he does not think all purchasers "necessarily think of it as an opiate." The "nootropic" label "reduces the idea that it's an illegal drug," he said. "And that appeals to some folks."

A main problem with this is that people "may come to assume that anytime they have a symptom or a problem they can go on the Internet and find something on their own without knowledge of where it's coming from or how the body uses it or how the body reacts to it," he said. Self-medicating in this way means that when problems arise, medical personnel "don't know how to intervene."

'Tip of the iceberg'

Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York, also warned of the dangers of tianeptine.

"With 207 calls to poison control centers detailing exposures to tianeptine within the last four years -- compared to just 11 calls in 14 years before -- it's clear we need to wake up to the potentials of misuse and abuse of this drug," Glatter, who was not involved in the CDC report, wrote in an email.

He also noted that the drug does not show up on standard drug screens, so people might decide to abuse it recreationally "to get high" without understanding potential negative side effects.

He said the reported recent high number "likely reflects the tip of the iceberg in an emerging picture of misuse and abuse of this antidepressant. But it also reflects the trend in patients searching for alternative medications to replace opiate painkillers in the midst of tightening of policies related to opiate prescribing."

He added that the CDC findings also suggest the need to focus greater attention and efforts on the way people with opioid use disorder are treated.

"Unless we can get people into medication assisted treatment programs in a more expedient manner, people will continue to misuse and abuse alternative prescription medications to avoid withdrawal and reduce cravings," he said.

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 159036

Reported Deaths: 3879
CountyCasesDeaths
DeSoto10563104
Hinds10414204
Harrison7397113
Jackson6655128
Rankin6057107
Lee540396
Madison5120107
Forrest394786
Jones376188
Lauderdale3663147
Lafayette341053
Washington3321108
Lamar301950
Oktibbeha255262
Lowndes252867
Bolivar248084
Panola237353
Neshoba2280122
Marshall225051
Leflore211191
Monroe209778
Pontotoc208131
Lincoln200566
Sunflower194155
Warren183058
Tate180451
Union172926
Copiah170840
Pike166760
Scott161330
Yazoo161340
Itawamba159936
Alcorn159328
Pearl River158969
Coahoma155943
Prentiss154931
Simpson154053
Adams147252
Grenada145445
Leake141844
Holmes134461
Covington130040
Tippah130030
George129525
Winston128726
Hancock127641
Wayne123024
Attala122834
Marion121447
Tishomingo114043
Chickasaw110732
Newton110529
Tallahatchie99427
Clay96127
Clarke94853
Jasper87023
Stone82015
Calhoun79513
Walthall79330
Montgomery78426
Carroll75515
Lawrence74614
Smith74216
Yalobusha74228
Noxubee73317
Perry68726
Tunica63019
Greene62422
Jefferson Davis59617
Claiborne59216
Amite57615
Humphreys55219
Quitman5107
Benton50418
Kemper48018
Webster47714
Wilkinson40722
Jefferson38312
Choctaw3637
Franklin3635
Sharkey32917
Issaquena1214
Unassigned00

Alabama Coronavirus Cases

Cases: 256828

Reported Deaths: 3711
CountyCasesDeaths
Jefferson34214511
Mobile20299366
Madison13925150
Tuscaloosa13591156
Montgomery12659238
Shelby1095877
Baldwin9163137
Lee792566
Morgan710851
Etowah677467
Calhoun6695121
Marshall665757
Houston548239
DeKalb504738
Cullman472043
St. Clair451857
Limestone447546
Lauderdale436054
Elmore427564
Walker3818111
Talladega374457
Jackson350723
Colbert336443
Blount310043
Autauga287342
Franklin259734
Coffee254115
Dale242054
Dallas232932
Chilton230841
Russell22813
Covington227934
Escambia206131
Tallapoosa189191
Chambers185950
Pike162214
Clarke161819
Marion146136
Winston141924
Lawrence135336
Pickens127720
Geneva12638
Marengo125224
Bibb123938
Barbour120629
Butler118842
Randolph105922
Cherokee105524
Hale99732
Fayette96316
Clay93525
Washington93319
Henry8946
Monroe83811
Lowndes82129
Cleburne79914
Macon76522
Crenshaw72930
Conecuh72414
Lamar7138
Bullock70919
Perry6927
Wilcox64918
Sumter58922
Greene44218
Choctaw43519
Coosa3724
Out of AL00
Unassigned00
Tupelo
Overcast
49° wxIcon
Hi: 51° Lo: 43°
Feels Like: 49°
Columbus
Broken Clouds
54° wxIcon
Hi: 54° Lo: 45°
Feels Like: 54°
Oxford
Overcast
41° wxIcon
Hi: 43° Lo: 37°
Feels Like: 38°
Starkville
Scattered Clouds
52° wxIcon
Hi: 50° Lo: 40°
Feels Like: 52°
WTVA Radar
WTVA Temperatures
WTVA Severe Weather