An antidepressant from the 1950s is now being marketed as an over-the-counter supplement to treat depression, anxiety, and opiate withdrawal, which is causing concern among health care workers and lawmakers.
The drug, tianeptine, is sometimes called “gas station heroin” because of its opiate effects, difficulty to quit without withdrawal side effects, and availability at gas stations.
Legislation is being considered in Mississippi, Georgia, and Florida to criminalize tianeptine, and the substance has been banned for over-the-counter sale in other states such as Indiana, Alabama, and Tennessee, although it can still be ordered online.
It can take up to a month for someone to become mentally stable again after detoxing from tianeptine, said Dr. Melissa Thompson of the Ivy Creek Detox Program at Elmore Community Hospital in Wetumpka, Alabama.
Antidepressant Drugs
Tianeptine is classified as a tricyclic antidepressant. It was used in the 1950s before selective serotonin reuptake inhibitors (SSRIs) became available in the 1980s with the introduction of Prozac, the brand name for fluoxetine.Tricyclic antidepressants have immediate effects, unlike SSRIs, which can take several weeks to take effect.
Tianeptine is still used as an antidepressant in France and other European countries but isn’t approved by the Food and Drug Administration for use in the United States.
“You don’t have to take it for very long before you get physically dependent on it,” Thompson said. “Before you know it, you have to keep using it to keep from withdrawing. And when you do withdraw off it, it’s like you are withdrawing off two to three drugs at one time.”
Among the symptoms of withdrawal are involuntary muscle movements, nausea, anxiety, and a feeling of doom, Thompson said.
Not the Only Designer Drug
Tianeptine follows a trend of legal designer drugs that come in various forms and can be purchased in smoke shops, gas stations, and online.It’s commonly referred to as Tianna, Tianna Red, and ZaZa.
Another designer drug recently targeted by lawmakers is the herbal supplement kratom, which binds with opiate receptors in the brain.
Obtained from the leaves of a kratom tree native to Southeast Asia, kratom has been banned in Alabama, Arkansas, and Indiana; Mississippi lawmakers are considering legislation that would criminalize both kratom and tianeptine.
“Many states outlawed kratom, but unfortunately, once you outlaw one, another one pops up,” Thompson said.
One of the problems with tianeptine is that many physicians haven’t heard of the drug, so they don’t know how to treat the symptoms of withdrawal.
“There’s not much information out there on how to help a patient,” Thompson said.
At the Ivy Creek Detox unit where she continues to see patients admitted with symptoms of tianeptine withdrawal, Thompson said patients are treated for their individual symptoms, such as muscle spasms and anxiety.
“We have a good combination of medicines that we use to help people come off of it,” she said. “Typically people come in for five days, and then I’ll give them medicine to taper off for the next 30 days because you can’t really come off of it completely in five days.”
The people getting hooked likely wouldn’t be perceived as stereotypical addicts, Thompson said.
“Certainly, we are seeing a lot of college students. We are also seeing average people—children and next-door neighbors—who were looking to manage their anxiety and depression,” Thompson said. “They aren’t who you would think of when you think of addicts.”
