From Antidepressant Tianeptine to Street Drug ZaZa: A Narrative Review

The confusion surrounding tianeptine must be cleared up: it is not a nootropic or harmless drug that can safely be sold over the counter or online without a prescription. The drug offers an initial and highly pleasurable euphoria, and this psychoactive effect makes it appealing to drug abusers who may combine it with other drugs in a “stack” for polysubstance abuse. Dependency is the expected result of prolonged exposure to supratherapeutic doses of tianeptine, triggering withdrawal symptoms if the drug is stopped abruptly or drastically reduced. Greater awareness is needed by the public who see this drug merely as a harmless over-the-counter cognitive enhancer; greater awareness is needed by merchants who sell this drug believing it is benign; and greater awareness is needed among clinicians in terms of discussing this drug with patients. Guidance as to how to treat tianeptine toxicity and rehabilitation are needed as well. Tianeptine represents a new and slow-moving public health crisis that must be efficiently and immediately addressed.