51 replies to this topic

[ikaros]

And I live in EU, Estonia. It's prescribed all over the Europe. I find it wierd that US keeps blocking the drug. I think it has more to do with US pharmaceutical companies not wanting a potent rival for their drugs, because tianeptine would be superior in many aspects.

[doug123]

Nootropikamil, compared to the SSRIs tianeptine is an innocent child. I did experience one side-effect which is usually common to serotonergic antidepressants and it was slight muscle cramps, but those weren't anything serious and went away in 5 days. By the way because I was diagnosed OCD, I have tried all SSRIs out there and I can say most of them are packed with side-effects and not just with side-effects you listed for tianeptine, but much worse kind of side-effects, (on fluvoxamine) for me the worst was a hypomanic episode which lasted 2 months (my doc rushed to diagnose me as a bipolar, but it was actually the med). I've been on tianeptine for over a month now and I still can't find anything bad about it, maybe slight energy rush time to time, but who whines about that, helps me pull more work and at the university I manage to get more studying done also.

Opales, our resident thinker, lays it down in the beginning of this topic.

Excellent review of tianeptine:
http://www.tianeptin...tianeptine.html

I do think it has been perhaps a little undeservedly (not that I don't think there is any promise to it) heralded in the smart drugs (i.e. amateur psychiatry) circles, IMO in the end it comes down to this

Like reboxetine1 and milnacipran2 and consistent with its primarily European development, most of the published trials of tianeptine have been active rather than placebo-controlled and results were not published in full with rigorous peer review, compromising the ability to critically assess efficacy.

Some people seem to have the tendency to rather opt for wishful extrapolations from preliminary/poor data rather than face the cold reality with substances that have better testing. Better testing means better knowledge of efficacy (or lack of it), and yes, better knowledge of adverse effects too.

ikaros: I don't know your data source(s) -- but please cite them. I would like to get going today...but...your statement in bold above is not consistent with the evidence available. You are welcome to present it; as I hope the data I have selected is incorrect...

The side effect profile of tianeptine is unfavorable compared to better studied/tolerated drugs. Of course there will be a mound of unsubstantiated hype and opinions on the Internet; that's why there is no authority on the web besides primary sources of data.

Let's compare side effect profiles of tianeptine (which is, by the way, NOT an SSRI) ane Citalopram

Side effects
Citalopram is safe and well tolerated in the therapeutic dose range of 20 to 60 mg/day. Distinct from some other agents in its class, Citalopram exhibits linear pharmacokinetics and minimal drug interaction potential, making it a better choice for the elderly, or comorbid patients.[1]

Citalopram can have a number of adverse effects. In clinical trials, over 10% of patients reported fatigue, drowsiness, dry mouth, increased sweating (Hyperhidrosis), trembling, headache and/or dizziness, sleep disturbances, arrythmia, blood pressure and ejaculatory problems. In rare cases (around over 1% of cases), some allergic reactions, convulsions, mood changes, anxiety and confusion have been reported. Occasionally, panic attacks, thoughts of suicide or self-harm may occur or increase in the first few weeks, before the antidepressant effect starts.[2]

Citalopram is contraindicated in individuals taking MAOIs. It is considered relatively safe in overdose, although fatal cases of dosages 840 mg to 1960 mg have been reported.[3]

Compared with over 1/3-1/5 of your patients experience dry mouth, 1/4-1/5 experience constipation, 1/5 experience dizziness/syncope, 1/6 experience drowsiness, 1/11 experience postural hypotension, and 1/5 experience Insomnia and nightmares with tianeptine ...

Only 1/10 of your patients have such side effects with Citalopram....yes, premature ejeculation is a bad side effect; but I don't believe many of the side effects monitored for drugs for use in the USA were studied in European trials when tianeptine was being studied for human use.

That is besides the point.

Tianeptine has very weak clinical trial data as well. Based on available evidence, its efficacy is still in question. And considering individuals actually take a drug hoping to induce neurogenesis when there is no evidence of such in any human trial, the amount of hype used to support the use of this drug for such applications is interesting.

[kottke]

The point is though, Adam, that it is very weak in side effects compared to every other SSRI except Citalopram. You also have: more control of the dosage, almost no withdrawal symtoms, no anticholigenic effects, and it has the oppisite effect of premature ejeaculation to actually increasing labido and most likely orgasm intensity. Not to mention it works for Ikaros, thus showing its efficancy.

Now im not a fan of insomnia or nightmares myself, but that may be a small price to pay next to having memory problems and not being able to get it up.

[doug123]

The topic is intended to point out that Tianeptine has never demonstrated neurogenesis properties in human beings...Lithium carbonate, on the other hand, has demonstrated these properties...however, only in bipolar subjects. Bipolar and depressed patients, it seems (based on available data) experience cellular atrophy in their brains...that's why they might benefit.

kotte: I randomly selected Citalopram -- I am off to the bookstore and to dinner now...when I get back, I will try to choose another SSRI for comparison purposes to further investigate Tianeptine's side effect profile when compared to SSRIs.

Tianeptine might be the best medicine in the world...and it might work perfectly for ikaros's OCD symtoms in particular...but one anecdotal report has little or no value.

Also: Tianeptine is NOT an SSRI. It is classified as an SSRE.

Regardless, according to the above cited review by Opales:

http://www.tianeptin...tianeptine.html

I do think it has been perhaps a little undeservedly (not that I don't think there is any promise to it) heralded in the smart drugs (i.e. amateur psychiatry) circles, IMO in the end it comes down to this:

CLINICAL USE/THERAPEUTIC INDICATIONS
Efficacy for Acute Treatment

Like reboxetine1 and milnacipran2 and consistent with its primarily European development, most of the published trials of tianeptine have been active rather than placebo-controlled and results were not published in full with rigorous peer review, compromising the ability to critically assess efficacy.

It seems a peer review of the data reveals that most of the studies performed on tianeptine were not double blind and ramdomized, making the findings of such studies largely worthless.

[ikaros]

Tianeptine has very weak clinical trial data as well. Based on available evidence, its efficacy is still in question. And considering individuals actually take a drug hoping to induce neurogenesis when there is no evidence of such in any human trial, the amount of hype used to support the use of this drug for such applications is interesting.

Yes, there is little data available compared to SSRIs (by the way I do know that tianeptine is not an SSRI), but enough evidence from European studies indicates that the drug really does something beneficial in the brain. If you need proof then go to pubmed and type in "tianeptine" and read the studies. Besides I posted some links in the beginning of the thread.
Also, I repeat again, tianeptine probably really really doesn't induce neurogenesis in HEALTHY NORMAL subjects. No neuroscientist has said that it does do that, currently the studies imply that it restores neurogenesis in indiviudals who are affected by chronic stress which according to the new paradigm of depression halts the normal neurogenesis in the human brain. Also it has potential to reverse other brain abnormalities associated with glutmaergic overexcitation.

The side effect profile of tianeptine is unfavorable compared to better studied/tolerated drugs.

Perhaps the side-effects you posted are more common with tianeptine, but some of the side-effects that SSRIs cause are much worse for any individual than those which are brought on by tianeptine. Maybe you know the website prozactruth.com which lists meticulously all the reported side-effects of antidepressants. With tianeptine nobody hasn't yet reported adverse reactions like aggression, mood swings, memory and concentration problems, even hallucinations and the list goes on. That's why I said "an innocent child" because it hasn't proven itself to be as messy as the SSRIs can be sometimes...well rather often in fact.

Actually based on the new theories about chronic stress and depression, it is resonable to speculate that any drug which lifts depression, stress or other burdensome condition, restores neurogenesis in the human brain. The one which gets you well sooner and without less side-effects, thus is superior. Of course this is all speculation, but because the brain happens to be insanely complex organ, research in this field lies mostly on speculation and theories.

[Brainbox]

What about the following hypothetical reasoning regarding drugs that do not find their way into normal day-to-day medical practice?

- A pharmaceutical company discovers a promising drug, i.e. one that might have neurogenesis capabilities.
- After the following investments in research and testing, the drug doesn't seem to live up to its promises. It has its use among a small group of patients, but the initial enthusiasm and the initial investments based on this enthusiasm did not provide the required returns.
- The market for nootropic drugs seems to be a huge and easy market for "dumping" drugs that did not live up the initial promises, since the customers that are part of this market are willing to try almost everything that has a remote chance of having nootropic effects provided the side effects are not to serious.
- So, consequently, the pharmaceutical company, or sales representatives that are associated with the company, decide to market the drug as nootropic. Marketing is easy. Just design a website that cites some of the promising research papers, make sure that the research is accessible by the general public through i.e. pubmed and the conditions for selling the medicine to nootropic users is created.
- The way to get at least some additional return on the research investments is created.
- The nootropic community, that grows on anecdotal and promising (but inadequate) research, steps into it willingly, amplifying or even creating a hype that will last for at least a few years.

I know I'm quite sceptical regarding nootropics. I do not have the scientific background like some of us, but making meta-level observations like the one above is some kind of capability I seem to have. I'm not right always, but most of the time I am. I do a lot of reading and studying on this subject.

I get the feeling most of the imminst members choose to ignore me, why is that?

Cheers, Bart.

[ikaros]

Brainbox, tianeptine hasn't been marketed as a nootropic by its manufacturer. As I understand some overly enthusiastical life-extensionist heard the word "neurogenesis" and instantly thought "immortal brain" or "super brain" or whatever they think. Tianeptine doesn't make anyone above normal, if it does its work correctly, it brings you to normal, but not above it. Besides I consider myself also as a sceptic (though right now I'm probably giving off a different impression), but I've been studying neurobiology for quite a time now (because of my condition), and to me it makes sense how it's supposed to work to alleviate symptoms of stress and anxiety.

[kottke]

Adam: I meant to say the "fact" is that tianeptine has very low side effects compared to SSRIs and i was branching that off of ikaros's statement, not the topic at hand. I also meant effeicancy by the fact that it does work for some people so that means technically that is "working". If you have depression one day and its lifted the next there is obviously something going on with your brain chemistry, and if its mostly having positive effects and is showing "benefit" than it is obviously "working" as it is intended. However; this doesnt mean its inducing neurogenesis. It could only be lifting depression.

[doug123]

Yes, there is little data available compared to SSRIs (by the way I do know that tianeptine is not an SSRI), but enough evidence from European studies indicates that the drug really does something beneficial in the brain.If you need proof then go to pubmed and type in "tianeptine" and read the studies. Besides I posted some links in the beginning of the thread.
Also, I repeat again, tianeptine probably really really doesn't induce neurogenesis in HEALTHY NORMAL subjects. No neuroscientist has said that it does do that, currently the studies imply that it restores neurogenesis in indiviudals who are affected by chronic stress which according to the new paradigm of depression halts the normal neurogenesis in the human brain. Also it has potential to reverse other brain abnormalities associated with glutmaergic overexcitation.



Perhaps the side-effects you posted are more common with tianeptine, but some of the side-effects that SSRIs cause are much worse for any individual than those which are brought on by tianeptine. Maybe you know the website prozactruth.com which lists meticulously all the reported side-effects of antidepressants. With tianeptine nobody hasn't yet reported adverse reactions like aggression, mood swings, memory and concentration problems, even hallucinations and the list goes on. That's why I said "an innocent child" because it hasn't proven itself to be as messy as the SSRIs can be sometimes...well rather often in fact.

Actually based on the new theories about chronic stress and depression, it is resonable to speculate that any drug which lifts depression, stress or other burdensome condition, restores neurogenesis in the human brain. The one which gets you well sooner and without less side-effects, thus is superior. Of course this is all speculation, but because the brain happens to be insanely complex organ, research in this field lies mostly on speculation and theories.

The evidence from European studies (as is addressed above is mostly from trials that did not involve a placebo or weren't randomized). Just because Pubmed says something does not make it automatically true -- that's why it's best to select peer reviewed data instead of the random hits on Pubmed. For all we know, tianeptine does nothing beneficial for the human brain. There isjust too little evidence to conclude one way or the other.

Research in the field of nootropics is based on finding the best evidence and selecting the ones that have the strongest evidence for further testing.

Brainbox lays it down:

What about the following hypothetical reasoning regarding drugs that do not find their way into normal day-to-day medical practice?

- A pharmaceutical company discovers a promising drug, i.e. one that might have neurogenesis capabilities.
- After the following investments in research and testing, the drug doesn't seem to live up to its promises. It has its use among a small group of patients, but the initial enthusiasm and the initial investments based on this enthusiasm did not provide the required returns.
- The market for nootropic drugs seems to be a huge and easy market for "dumping" drugs that did not live up the initial promises, since the customers that are part of this market are willing to try almost everything that has a remote chance of having nootropic effects provided the side effects are not to serious.
- So, consequently, the pharmaceutical company, or sales representatives that are associated with the company, decide to market the drug as nootropic. Marketing is easy. Just design a website that cites some of the promising research papers, make sure that the research is accessible by the general public through i.e. pubmed and the conditions for selling the medicine to nootropic users is created.
- The way to get at least some additional return on the research investments is created.
- The nootropic community, that grows on anecdotal and promising (but inadequate) research, steps into it willingly, amplifying or even creating a hype that will last for at least a few years.

You should really try to form a proper rebuttal to the issues Opales, brainbox and myself have raised.

Edited by nootropikamil, 14 August 2006 - 09:43 PM.

[doug123]

What about the following hypothetical reasoning regarding drugs that do not find their way into normal day-to-day medical practice?

- A pharmaceutical company discovers a promising drug, i.e. one that might have neurogenesis capabilities.
- After the following investments in research and testing, the drug doesn't seem to live up to its promises. It has its use among a small group of patients, but the initial enthusiasm and the initial investments based on this enthusiasm did not provide the required returns.
- The market for nootropic drugs seems to be a huge and easy market for "dumping" drugs that did not live up the initial promises, since the customers that are part of this market are willing to try almost everything that has a remote chance of having nootropic effects provided the side effects are not to serious.
- So, consequently, the pharmaceutical company, or sales representatives that are associated with the company, decide to market the drug as nootropic. Marketing is easy. Just design a website that cites some of the promising research papers, make sure that the research is accessible by the general public through i.e. pubmed and the conditions for selling the medicine to nootropic users is created.
- The way to get at least some additional return on the research investments is created.
- The nootropic community, that grows on anecdotal and promising (but inadequate) research, steps into it willingly, amplifying or even creating a hype that will last for at least a few years.

I know I'm quite sceptical regarding nootropics. I do not have the scientific background like some of us, but making meta-level observations like the one above is some kind of capability I seem to have. I'm not right always, but most of the time I am. I do a lot of reading and studying on this subject.

I get the feeling most of the imminst members choose to ignore me, why is that?

Cheers, Bart.

Bart: your ideas are always well stated and thought through. If you don't get a reply on the issues you raised, that often means you've said what needs to be said so well no one could say it better. Besides posting your view on a topic, try integrating a question or two into your posts (not rhetorical questions) and see how that works.

[kottke]

Ikaros, hows the Tianeptine treating you?

[ikaros]

Well I'm still overall pleased with the drug. But unfortunately there are still some odd problems which I think have something to do with tianeptine, but that's my amateurpsychiatric evaluation. Anyway so far I'd list the pros and cons like this:

Pros:
-significantly reduced anxiety
-significantly reduced compulsive behaviour (I'm a less of a control freak as I used to be)
-better motivation (this might be from the two above, but I'm thinking it affects dopamine in some way so that you see more point in things again)
-less impulsivity (I feel like a wise 70 year old, but without dementia and wrinkles)

Cons:
-the three times a day dosing is driving me nuts
-if I miss a dose then I seem to experience pretty bad anxiety (but not always)
-I hoped it would combat my drowsiness and concentration difficulties which I've had around for ages, but it doesn't seem to do that, so I'm also taking a very low dose methylphenidate along, but I'm probably switching that to something else
-less impulsivity (yeah I actually liked that time to time)

In conclusion tianeptine will continue to stay in my system.

[poser]

How long did it take to get those effects?

Modafinil is excellent for drowsiness. I have ordered selegiline for motivation/focus.

[ikaros]

Some euphoric anxiety-free effects I felt on the second day already which I think were more due to placebo (because it makes more sense like so). But I can say the stress which I was experiencing prior to tianeptine lifted in 2-3 weeks.

[mammalspod]

Basically what is being argued here is the relative pertinence of hard scientific facts as they involve SUBJECTIVE EXPERIENCE. It has been my experience that with psychological drugs such as Tianeptine, data collected through scientific rigor has limited usefulness. If I were to assess whether or not to use a drug like paroxetine based solely on hard data I would be evaluating percentages of side effects and statistical efficacy compared to other drugs prescribed for the same reasons. Some of the categories of eficacy of mood altering drugs are determined using Questionnaires and other subjective data collection. However, these findings are put under the perception of using the scientific method because they are in the form of numbers and percentages. The obvious problem when dealing with psychoactive drugs is that in a lot of cases it seems non-scientific data may describe the experience one is more likely to have than "scientific" data. The strict adherence to using data which gives the impression of being derived from the scientific method has unfortunately permeated the American Psychiatric field. If a person has symptoms consistent with depression they are usually given the drug ehich has shown to be effective and have the least measurable side effects (SSRI's ). Rarely is there an attempt to discern which form of depression is working or which type of chemicals might be better utilized. This would be considered more speculative and less "scientific". All of this represents a fervent debate in the psychological sciences over the value of having the same type of expectations for reliance on scientific rigor as the other medical practices. Luckily, brain scan imaging technology is advancing such that debates like these (neroplasticity effects of various drugs) will easily be resolved in a short time. For now I will continue to see these treatments for what I feel they are, psychotropics. I will order things that seem to be potential life enhancers and weigh the effects for myself. In 5 years if I feel permanently and beneficially altered I will sit back and say to myself "Huh, I guess there might have been something to all that hippocampus regeneration anyhow".

[fntms]

If I may just chime in here...

I've been using tianeptine 3x day for about 1.5 years for bad anxiety/panic (and I think some depression although this was not diagnosed) and I have zero side effects. No bp increase, no dry mouth, no nightmares (unless I take it late at night just before sleep, then I can get the odd nightmare), no sedation, no sex problems whatsoever. I know what those are like, since I had to get off effexor after just two months because of anorgasmia (effexor is a very effective drug though, too bad about the sides for me...also it made me feel a little doped up and the dry mouth...!)
My anxiety is gone to a very large extent thanks to tianeptine, and there are periods of zen-like "bliss" when I can take on anything...but I have a very stressful job (plus relationship issues at times) and sometimes I still need the odd low dose benzo / hydroxizine...

[ikaros]

Basically what is being argued here is the relative pertinence of hard scientific facts as they involve SUBJECTIVE EXPERIENCE. It has been my experience that with psychological drugs such as Tianeptine, data collected through scientific rigor has limited usefulness. If I were to assess whether or not to use a drug like paroxetine based solely on hard data I would be evaluating percentages of side effects and statistical efficacy compared to other drugs prescribed for the same reasons. Some of the categories of eficacy of mood altering drugs are determined using Questionnaires and other subjective data collection. However, these findings are put under the perception of using the scientific method because they are in the form of numbers and percentages. The obvious problem when dealing with psychoactive drugs is that in a lot of cases it seems non-scientific data may describe the experience one is more likely to have than "scientific" data. The strict adherence to using data which gives the impression of being derived from the scientific method has unfortunately permeated the American Psychiatric field. If a person has symptoms consistent with depression they are usually given the drug ehich has shown to be effective and have the least measurable side effects (SSRI's ). Rarely is there an attempt to discern which form of depression is working or which type of chemicals might be better utilized. This would be considered more speculative and less "scientific". All of this represents a fervent debate in the psychological sciences over the value of having the same type of expectations for reliance on scientific rigor as the other medical practices. Luckily, brain scan imaging technology is advancing such that debates like these (neroplasticity effects of various drugs) will easily be resolved in a short time. For now I will continue to see these treatments for what I feel they are, psychotropics. I will order things that seem to be potential life enhancers and weigh the effects for myself. In 5 years if I feel permanently and beneficially altered I will sit back and say to myself "Huh, I guess there might have been something to all that hippocampus regeneration anyhow".

That's why there are procedures like double-blind placebo which is a very effective means to prove a drugs effectiveness compared to a sugarpill. I agree although that pyschotropic drug use is way over generalized for very different forms of depression, anxiety etc

Anyway my humble follow-up report on tianeptine:
I discontinued it after 3 months of use. I don't know was it my peculiar neurochemistry, but I seem to develop tolerance to almost every psychotropic drug, including SSRIs which should retain their effectivness over long-term. Even though the beginning was a bliss, it eventually made me feel wierd. I have OCD, so it might have been just that I wasn't using the right drug for the condition. I'm currently on fluoxetine which is working moderately well and has improved my attention span. Natural methods don't work for me (tried most of them).

[edward]

I tried Tianeptine a while back as an alternative to the SSRI I had been taking for years. I gave it a good 4 months after I withdrew from my SSRI (prozac/fluoxetine). Although it was perhaps better than placebo, my depression was definitely much worse than on the SSRI and my anxiety was increased. I noticed no other cognitive benefits and perhaps a bit of cognitive decline. Another member of my family that has roughly the same profile with regards to depression and anxiety also tried this drug after I started. Though he didnt give it 4 months like I did his results were the same.

I honestly don't think Tianeptine is worth it, maybe not worthless but pretty close. Good theory, good hype but bad real world results.


PS. Haven't been on here for a while due to an extreme work and school schedule, haven't disappeared as some do, just extremely busy, you know its bad when you are having to schedule in sleep days in advance.

[krillin]

I honestly don't think Tianeptine is worth it, maybe not worthless but pretty close. Good theory, good hype but bad real world results.

Me too. I gave it 6 months at three tabs a day. It was utterly useless for battling mold allergy anxiety. At least the side effects weren't bad: just a little dry mouth and constipation the first week.

[austix]

I use tianeptine 12.5 mg 3 tmies a day. Results have been very positive and not a placebo effect. This drug reduces anxiety. It stops me from excessive worry and it has allowed me to move off of other anti depressents. Side effects are non existent. It also seems to be prosexual vs most other anti depressents that I have been prescribed and which limit either desire or performance.

I have been on a long search for something to turn down my anxiety level. It is extreme and to some degree it has been a strong moitivator. Worry makes me move my ass. But in the end extreme anxiety spins me to a stop. When that happens--grinding to a halt-- severe depression sets in. This results in highly creative thinking, an obsession with art in all forms and a black cloud that hovers over me and anyone near to me. I hate this cycle. To the point of suicide. You know you are in real trouble when the thought of suicide makes you smile-makes you joyful. A solution is emminent. The relief of suicide is profound.

Tianeptine is the only thing that has really worked for me. The first month I remained skeptical. My depression comes in odd looping cycles not exactly predictable but I always have a sense of experience as elliptical and reoccurring. Tianeptine semms to have disrupted the ellipse. Life seems now to have a forward direction rather than a sad, spooky ride on a mad man's merry-go round.

I'm all for the clinical studies and have learned from trial and error that very few things have the power of their pitchman's claims. But this one works for me. Dry mouth? Are you joking. A man with a noose around his neck has bigger things to worry about. Constipation? This is a side effect? Please. Take a glass of medimucil or eat a bag of celery.

I know the disdain of unsupported claims. Yes my diet may have changed, I might exercise more than before. it might not be tianeptine it might really be the fumes off my dog's new reduced fat kibble. Only I know it is the tianeptine.

For me it works. It might for others. That it is not available to Americans is not a surprise. Order it from others if you are over your head.

jdl

[odeja]

I tried a three-times-a-day regimen for a few days, at a very low dosage (wisely, it turns out). 3mg or less three times a day.

I didn´t feel much of anything the first few days, except for some transient headaches and very minor mood swings, which may or may not have been the drug´s doing. On day 4-5 I started feeling pain at various locations in my abdomen that just increased in intensity over time, so I stopped. I had also become very tired and headache-ridden.

I think I´m done with this one, aside from occasionally attempting a one-off dosage at various modest levels and seeing what that yields (if anything), since that approach seems not to produce unacceptable side-effects. Or at least doesn´t allow them the time to manifest.

Edited by odeja, 26 August 2007 - 10:00 AM.

[Sirach]

In taking tianeptine it never struck me that taking it chronically would be of any great help mood wise, clearly this is hypothetical though. My immediate impression on taking tianeptine was how subjectively *weaker* it felt to the ssri's- perhaps a slight enhancement in concentration or enjoyment in independant tasks like browsing the internet. More interestingly, the relationship between past feelings and memories seemed to be more accessible and took on a greater meaning. Weird. I agree though, 3 x a day is reason enough (regardless of any theraputic action) to put me off taking this regularly. There does seem to be some 'comedown' where, unless you redose, you feel worse than you did before taking original dose. Good one for 'as and when' perhaps, assuming 'when' is about 3 hours before bed.