Hi Dr. Phelps,

I haven't found any information about tianeptine and bipolar disorder. I know that tianeptine is not accepted in USA and therefore there is no info about it on your website. interesting thing is though, that it's an only antidepressant that acts in a totally different way than SSRI-s - it REDUCES serotonin. but at the same time it brightens mood.

I'm diagnosed as BP II. I was very aware of the AD controversy, but I didn't also want to take mood stabilizers.. my pdoc then prescribed me tianeptine (I live in Europe where it's available), saying that it's an only antidepressant that doesn't cause mania. it's also very good for anxiety.

I've taken tianeptine for 10 days, and I feel a bit calmer, and my mood is not fluctuating so much. I feel more positive. early to say, but I'm quite satisfied so far. 

(background info - I had severe depression in autumn 2006, treated with cipramil,  which didn't help, but i crawled out of the hole.. then in june/july i started to get depressed again. in aug/sept I took lamotrigine, but I felt drowsy and stopped. went on with the help of CBT until know, when i started also taking tianeptine).

I have an old and experienced pdoc, but I'd be really interested to hear what you think about tianeptine?

thanks in advance,
Diane 

Dear Diane --

Thank you for the question. Good for my learning curve. Unfortunately, other than educating myself, I don't think anything particularly useful is going to come of this. Because we do not have this medication in the United States, I have no personal experience with it. Nor do I hear colleagues talking about it.

So, the first thing I did was to enter tianeptine bipolar in a search engine for the national Library of medicine (pub med). To my great surprise, as I have heard about this medication in various psychiatric publications, always in the context of the treatment of depression, this search produced only 11 papers. Using that search engine, nearly any topic you enter produces tens or hundreds of papers. For example, entering the terms citalopram bipolar produced a list of 60 papers (citalopram is the generic name for cipramil). Of those 11 papers not a single one examines the use of tianeptine in bipolar disorder. That is really quite amazing. 

On the other hand, nearly everything that is clearly an antidepressant has proved to have the same disadvantage in the treatment of bipolar disorder, namely a risk of inducing manic-side symptoms and possibly destabilizing things so that other treatments are less likely to work. For example, this is true of St. John's wort, light therapy, and transcranial magnetic stimulation (TMS); notable exceptions are exercise and fish oil. So in the absence of any data, I think the most prudent assumption would be that tianeptine probably does carry the risk of destabilizing things just like any other antidepressant. I don't think we have any research evidence that could allow one to say that this medication "doesn't cause mania". For that, we would need some sort of observational trial at minimum. On the other hand, if your psychiatrist is a very experienced clinician, with years of experience, she may have her own "database" of sorts from which to make this claim, which needs to be respected in the absence of any other data to go on.

Thanks for an interesting question.

Dr. Phelps



Published March, 2008