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ABSTRACT
Tianeptine addiction: a case report
Common clinical problems associated with antidepressant therapy, are usage of a lower dose than recommended and cessation of the drug prematurely by the patients themselves. Withdrawal symptoms have been known for a long time, but other features of addiction, such as tolerance and compulsive drug use are very rare. The neurobiological properties of tianeptine involve a dynamic interplay between numerous neurotransmitter systems. The effects of tianeptine on the glutamatergic system can provide a key action in the cascade of events triggered by this compound and its antidepressant efficacy. In this article, with particular emphasis on the effects of tianeptine on the glutamatergic system, the abuse potential of the drug was explained through a case with "Tianeptine addiction" diagnosis.
Key words: Addiction, antidepressant, tianeptine
ÖZET
Tianeptin bagimliligi: Bir olgu sunumu
Antidepresan kullanimiyla ilgili olarak, genellikle rastlanan klinik problemler, hastanin ilaci söylenenden daha düsük dozda almasi ve istenilenden daha erken tedaviyi sonlandirmasidir. Antidepresanlarla çekilme belirtilerinin olmasi uzun zamandir bilinen bir bilgidir fakat tolerans ve kompulsif ilaç kullanimi gibi bagimliligin diger özellikleri oldukça nadirdir. Tianeptinin nörobiyolojik özellikleri, birçok nörotransmitter sisteminin dinamik etkilesimini içermektedir. Glutamaterjik sistem üzerine etkilerinin, bu molekülün tetikledigi olaylar zincirinde ve antidepresan etkinliginde anahtar role sahip oldugu düsünülmektedir. Bu makalede de, "tianeptin bagimliligi" tanisi konmus olan bir vaka üstünden tianeptinin kötüye kullanilma potansiyeli özellikle glutamaterjik sistem üzerine olan etkileri üstünde durularak açiklanmaya çalisilmistir.
Anahtar kelimeler: Bagimlilik, antidepresan, tianeptin
INTRODUCTION
It is common knowledge that antidepressants can cause withdrawal symptoms, however other properties of addiction such as developing tolerance and compulsive drug use are very rare (1,2). The usually seen clinical problems are; usage of a lower dose than recommended and cessation of the treatment before the planned time by the patient. Pharmacodynamics of most antidepressants and the absence of an acute euphoria or "high" after taking the medication theoretically eliminate the possibility of addiction.
Addiction can be defined as a syndrome characterized by compulsive substance abuse. It is generally accepted that the antidepressant drugs do not cause addiction; however there are studies in the literature that challenges this idea. Haddad's review on antidepressant addiction (3) searched through all the literature in English for antidepressant addiction, starting from 1963. The study reported 21 cases which satisfy the substance abuse...