Researchers reviewed 25 studies about tianeptine, a medication sometimes sold as a dietary supplement under names like “gas station heroin.” While it’s approved to treat depression in some countries, it can be highly addictive and is increasingly being misused. The study found that misuse is spreading, especially in North America, and that people often take dangerously high doses, sometimes mixing it with alcohol or other drugs. The findings show we need better rules and treatment options to prevent addiction and overdoses from this drug.

The Quick Take

  • What they studied: How often people misuse tianeptine, who is most at risk, what happens when they overdose, and whether current treatments work
  • Who participated: Analysis of 52 documented cases of tianeptine misuse from 25 different research studies published worldwide
  • Key finding: About 35% of people misusing tianeptine experienced overdoses, especially when taking very high doses (up to 20 grams daily) or mixing it with alcohol or sleeping pills. Naloxone (the overdose reversal drug) only worked in about 17% of cases, suggesting tianeptine may not respond like typical opioids.
  • What it means for you: If you or someone you know is using tianeptine, especially from non-medical sources, there’s a real risk of addiction and overdose. Current emergency treatments may not work as expected, making prevention and professional help crucial. This is particularly important because the drug is sometimes sold in convenience stores without proper warnings.

The Research Details

This was a systematic review, which means researchers carefully searched multiple medical databases (PubMed, Embase, and others) for all published studies about tianeptine misuse. They found 1,562 potential studies but only included 25 that met strict quality standards. They then analyzed the information from these studies to identify patterns in who misuses the drug, how they use it, and what happens to them.

The researchers organized their findings by looking at geographic regions, the types of people affected, how the drug was taken, and what medical problems resulted. They used statistical tests to determine whether the patterns they found were meaningful or just random variation. This approach is considered one of the strongest ways to understand a health problem because it combines information from many different studies rather than relying on just one.

A systematic review is important because it gives us the complete picture of what we know about a problem. Instead of one doctor’s experience with a few patients, this approach combines evidence from researchers around the world. This helps doctors and public health officials understand how serious the problem is and where to focus prevention efforts. It also identifies gaps in our knowledge about what treatments actually work.

The researchers followed strict international guidelines (PRISMA 2020) for conducting systematic reviews, which increases confidence in their findings. They assessed the quality of each included study using a standardized checklist. However, the studies they reviewed varied in quality and size, and many were case reports (stories of individual patients) rather than large controlled studies. The relatively small total number of documented cases (52) suggests this problem may be under-reported or that good data is hard to find. The researchers were transparent about these limitations.

What the Results Show

The research revealed that tianeptine misuse is not evenly distributed around the world. North America accounts for about 77% of documented cases, while Asia has about 15% and Europe has about 8%. This suggests the problem is much more severe in North America, possibly because the drug is more available there as an unregulated supplement.

Most people misusing tianeptine were male (about 56% of cases), and the majority took it by mouth rather than injecting it (71% took it orally). However, some people did inject it intravenously, which carries higher risks. About 58% of people showed signs of habitual, repeated use, indicating addiction was common.

Overdoses were a significant concern, occurring in about 35% of cases. These overdoses were strongly linked to taking very high daily doses (up to 20 grams) and mixing tianeptine with other drugs. Specifically, 11.5% of cases involved mixing it with alcohol, and 9.6% involved mixing it with benzodiazepines (prescription sleeping pills or anti-anxiety medications). These combinations appear to be particularly dangerous.

Withdrawal symptoms—the uncomfortable physical and mental effects that happen when someone stops using the drug—occurred in about 42% of cases. This is a sign of true addiction. Treatment options were limited: only a few cases used buprenorphine (a medication that helps with opioid addiction) or supportive care.

An important and surprising finding was that naloxone, the standard emergency drug used to reverse opioid overdoses, only worked in about 17% of treated cases. This is concerning because naloxone is very effective for heroin and prescription opioid overdoses. The lower effectiveness with tianeptine suggests the drug may work differently in the body than typical opioids, or that overdoses from tianeptine may involve different mechanisms of harm. This means emergency responders may need different approaches to treat tianeptine overdoses.

The research also highlighted that tianeptine’s availability as an unregulated dietary supplement in some regions makes it easy for people to access without medical supervision or warnings about addiction risks. The lack of regulation appears to be a major factor in the growing misuse problem.

The researchers noted that tianeptine’s addictive potential has been recognized for over 20 years, but systematic data on misuse has been surprisingly limited until now. This review is one of the first comprehensive looks at the problem. Previous research had identified that tianeptine acts on opioid receptors in the brain (similar to heroin and prescription painkillers), but this review provides the first detailed picture of how widespread misuse has become and how it’s affecting different populations. The findings confirm earlier concerns that were raised about the drug but provide concrete evidence of the scope of the problem.

Several important limitations should be considered. First, the total number of documented cases (52) is relatively small, which means findings may not represent all people who misuse tianeptine—many cases likely go unreported. Second, most of the information came from case reports of individual patients rather than large controlled studies, which means we can’t always be certain about cause and effect. Third, the studies were conducted in different countries with different healthcare systems, so some cases may have been missed or documented differently. Fourth, the review only included published studies, so cases treated in emergency rooms or by private doctors that weren’t published may not be included. Finally, the quality of the original studies varied, and some important information (like exact doses or outcomes) was missing from some reports.

The Bottom Line

Based on this research, here are evidence-based recommendations: (1) Avoid using tianeptine outside of legitimate medical settings where a doctor prescribes it for depression—the risk of addiction is high. (2) If you are currently misusing tianeptine, seek professional help immediately rather than trying to stop on your own, as withdrawal can be serious. (3) Never mix tianeptine with alcohol or other drugs, as this dramatically increases overdose risk. (4) If you know someone using tianeptine recreationally, encourage them to speak with a healthcare provider about treatment options. (5) Public health officials should work toward better regulation of tianeptine’s availability as a supplement. These recommendations have moderate to high confidence based on the evidence reviewed.

This research is most relevant to: people who are currently using or considering using tianeptine; family members concerned about someone’s drug use; healthcare providers and emergency room doctors who may encounter tianeptine overdoses; public health officials making policy decisions; and pharmacists who may see customers buying tianeptine supplements. People with depression should know that while tianeptine is a legitimate medication in some countries, it carries addiction risks and should only be used under medical supervision. This research is less relevant to people who have never used the drug and have no risk factors for substance misuse, though it’s still good general knowledge.

If someone is misusing tianeptine and seeks treatment, withdrawal symptoms typically begin within 24-48 hours of stopping use and may last 1-2 weeks, though some symptoms can persist longer. Recovery from addiction is a longer process—most people benefit from professional treatment lasting several weeks to months. It’s important to understand that addiction recovery is not quick, and professional support significantly improves success rates.

Want to Apply This Research?

  • If someone is working to reduce or stop tianeptine use, they could track: (1) Daily amount used (in grams), (2) Number of doses per day, (3) Any withdrawal symptoms experienced (rated 1-10 for severity), (4) Days since last use, and (5) Any co-use of alcohol or other substances. This data helps show progress and identifies patterns.
  • Practical changes users could make: (1) Set a daily reduction goal (e.g., decrease by 1 gram every few days) if medically supervised, (2) Log each dose immediately after taking it to increase awareness, (3) Record triggers that lead to use (stress, certain times of day, specific locations), (4) Set reminders to contact a healthcare provider or counselor, (5) Track alternative coping strategies used instead of taking the drug (exercise, meditation, calling a friend), and (6) Monitor sleep quality and mood to identify withdrawal symptoms early.
  • Long-term tracking should include: weekly check-ins on total weekly usage amount, monthly assessments of withdrawal symptom severity, tracking of any medical appointments or treatment sessions attended, monitoring of co-occurring substance use, and periodic notes on overall wellbeing and motivation. Users should share this data with their healthcare provider to adjust treatment as needed. Setting milestone celebrations (e.g., 1 week, 1 month, 3 months of reduced use) can help maintain motivation.

This research summary is for educational purposes only and should not replace professional medical advice. Tianeptine misuse is a serious health condition that requires professional treatment. If you or someone you know is struggling with tianeptine use, addiction, or overdose, please contact a healthcare provider, poison control center, or emergency services immediately. In the United States, call 911 for emergencies or the SAMHSA National Helpline at 1-800-662-4357 for free, confidential support 24/7. Do not attempt to treat tianeptine addiction or withdrawal without medical supervision, as serious complications can occur. This summary reflects the findings of one systematic review and should be considered alongside other medical evidence and professional guidance.