Introducing tianeptine — an antidepressant with a dark side.
Its mimicry of opioid effects, coupled with easy accessibility in the United States (US), has earned it the nickname “Gas-Station Heroin”. For individuals already grappling with opioid addiction, the deceptive marketing of tianeptine as a dietary supplement only escalates the problem, as it enforces the mistaken understanding that it may be a safer (and legal) alternative to street opioid drugs.
Not just another antidepressant
Tianeptine was originally produced in the 1960s by a group of French researchers for treatment of depression. To this day, it is approved at low doses for prescription use in parts of Latin America, Europe, and Asia, but not in the UK and the US. It can be effective for some people suffering with depression.
Unlike classic antidepressants, which increase levels of ‘mood-boosting’ factors in the brain such as serotonin, tianeptine appears to reduce brain serotonin levels. It is believed that tianeptine’s antidepressant affects are underscored by its ability to prevent changes in brain structure and function caused by stress. The drug is recognised as safe and effective when used at the proper dose and under prescription.
However, unlike classic antidepressants, high doses of tianeptine activate the same brain mechanism activated by Class A opioids like heroin and fentanyl (mu opioid receptors), and indeed people report that it can create a sense of euphoria.
Unsurprisingly, this also means that after using tianeptine, the same withdrawal symptoms associated with classic opioid drugs arise — including nausea, insomnia, depression, agitation, and diarrhoea. Moreover, tolerance to tianeptine develops rapidly, requiring abusers of the drug to escalate their dosage in order to recapture the pleasurable effects. Indeed, it has been found that individuals are taking tianeptine at doses over 100 times greater than recommended for therapeutic purposes, equivalent to 200 tablets a day. However, this only increases the severity of the “dopesick” symptoms, leading to a destructive cycle where abusers feel the need to take more tianeptine as withdrawal symptoms kick in.
Slipping through the cracks as a dietary supplement
Clearly, tianeptine is a dangerous drug, so how has it managed to be so freely available?
While tianeptine is not approved for prescription use in the US, it is here that it is raising the largest concerns. This is because it is easily and readily available as a nootropic agent — sold in small colourful bottles under names such as “Za Za”, “Neptune’s Fix”, and “Tianna”, at gas stations, liquor stores, smoke shops and even online. Manufacturers claim that these supplements can boost mood and improve cognition.
In 2022, the Food and Drug Administration (FDA) did issue a consumer warning that tianeptine was being illegally marketed as a dietary supplement. Furthermore, they claimed that they do not approve it for any medical use and warn that it is harmful and addictive. However, they are unable to impart much regulation on dietary supplements. Indeed, under the Dietary Supplement Health and Education Act (DSHEA, 1994), the FDA “does not have any authority to approve dietary supplements for safety… or to approve labelling, before the supplements are sold to marketing”. Instead, they rely on companies taking responsibility to ensure their products are safe. In the case of nootropics containing tianeptine, the cracks in this system have become prominent. While the FDA are now taking regulatory action to prevent the marketing of tianeptine products, imparting a nationwide ban is not currently possible.
Despite the FDA rightfully stating that "availability is no indication of effectiveness or safety", it should be considered that the average person, even if they see tianeptine as a listed ingredient, will not be aware that it could have opioid-like effects without the presence of informative or warning labels.
Social media has also played a role in the rise of tianeptine usage, with several platforms facilitating misinformation and promoting tianeptine’s positive effects. However, with the rise of tianeptine misuse has also come a rise in people trying to spread word of its negative, addictive effects. Especially on social media platforms, like TikTok, people are trying to curb the narrative of tianeptine and produce public awareness videos to warn people of its harmful properties.
Intersection with addiction
A recent and interesting article for the New York Times describes the devastating effects this drug can have for people struggling with addiction. The article recalls a story of how a man who had recently come out of rehab was intrigued by the apparent mood-boosting properties of “Neptune’s Fix”, under the false pretence that it was being sold so openly in shops and thus it must be safe and non-addictive. However, the immediate positive effects and rapid onset of withdrawal quickly hooked him, and he was eventually using five bottles a day. Soon, he collapsed in a preschool car park, after suffering from an overdose.
Sadly, stories like this have become all too common. People with a history of addiction are initially captured by the notion of a drug which gives them the same feeling as opioids, but is easily accessible and legal, leading them to believe they are safe. Maybe they start to feel they have found something which can help curb their addiction without destroying their lives. Devastatingly, a recent study reports on a case of a baby born to a mother taking these dietary supplements during pregnancy to mitigate chronic pain without knowledge of their harmful effects. Following birth, the child quickly developed symptoms of severe opioid withdrawal.
For addicts, recovering addicts, or people who have never even tried opioids, these dangerous “dietary supplements” are incredibly damaging to both physical and mental health. The pervasive false marketing of tianeptine not only draws people with addiction into another hazardous cycle, but also contributes to an undeserved tarnishing of the reputation of legitimate antidepressants, obscuring their potential benefits for those who genuinely need them.