Abstract

Background

Tianeptine is an atypical tricyclic antidepressant prescribed for depression and anxiety disorder. Despite being FDA unapproved in the US, it is sold online as a supplement.

Aim

We report a case of a 32-years-old male using tianeptine as a supplement outside the therapeutic dosage for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) and developing tolerance and dependence overtime. 

Case Presentation

A 32-year-old male presented to a clinic in Ozark, MO with the complaint of being 'hooked' on his ADHD supplement. He complained that stimulant medication that he was using since childhood for ADHD lost its efficacy after prolonged use and he started experimenting with ADHD supplements including tianeptine. He initially started with 60mg/day tianeptine purchased from online vendors and reported improved mood and motivation, but lost these effects after 4 weeks of daily usage. As a supplement, he felt safe to increase dosage to 180mg/day to achieve those initial effects and continued to escalate his dosage, reaching 900mg/day. Eventually, he found it financially difficult, and decided to stop using it. Within 5 hours of discontinuation, he experienced dysphoria, nausea, sweating, palpitations, GI upset, and tremors that resolved after ingestion of tianeptine. For the next two months, his repeated attempts to discontinue tianeptine were unsuccessful. Finally, he decided to visit Urgent Care where he was given benzodiazepines for withdrawal symptoms and eventually referred to ER for further management.

Conclusion

This case highlights the need to recognize and educate patients of potential abuse of tianeptine and its ability to produce physical dependence after prolonged use. Our case also emphasizes the need to have strict regulation over the purchase and distribution of tianeptine in the United States.