Abstract
Tianeptine is an atypical tricyclic antidepressant, the efficacy of which in the treatment of depressive episodes, dysthymia, adjustment disorder, and anxiety is comparable with the selective serotonin reuptake inhibitors (SSRI). The main mechanism of tianeptine’s action is based on the modulation of stress axis activity and increase of serotonin reuptake with additional pro-dopaminergic effects. Despite the many advantages, we find more and more reported cases of addiction to tianeptine, due to its psychostimulant properties and lack of side effects. It is reported in the literature that the dependence index (the so-called DSI – doctor shopping index) for tianeptine is at a level similar to benzodiazepines. We present the case of a 43 year-old woman with bipolar disorder and multiple drug abuse, who took tianeptine up to the dosage of 1125 mg/day (90 tablets). Treatment with valproic acid, bupropion and sertraline resulted in a gradual improvement of her mental condition, enabling her to function satisfactorily day to day.