title: Possible usefulness of tianeptine in treatment-resistant depression.
abstract: OBJECTIVE
  Tianeptine is an atypical antidepressant drug, augmenting serotonin reuptake and preventing stress-associated changes in the brain. In this paper, we present the use of tianeptine in eight American treatment-resistant patients with major depressive disorder.
  
  
  METHODS
  Two male and six female patients with major depressive disorder, aged 44-72 years with duration of the illness 3-40 years, were studied. All met criteria for treatment-resistant depression (TRD) as they failed four or more trials of medication, and two failed both ECT and Vagal Nerve Stimulation trials. In three patients, the drug was used as monotherapy, and in five, it was added to ongoing antidepressant treatment.
  
  
  RESULTS
  The remission (≤ 7 points on the 17-item Hamilton Depression Rating Scale) after 8 weeks of treatment was obtained in four female patients (50%). Of them, three still require other psychotropic medications to remain in remission and all four responders have been in remission with ongoing treatment with tianeptine for > 2 years. In two patients, the drug was terminated due to the incidence of delirium, and in one, it was due to severe agitation.
  
  
  CONCLUSIONS
  The results may suggest a possible usefulness of tianeptine in selected patients with TRD. They also point to a possible serious side effect of this drug not hitherto reported.
authors.affiliation: Department of Psychiatry, Cooper Medical School of Rowan University , NJ , USA.
authors.forename: Edward H
authors.initials: EH
authors.lastname: Tobe
authors.forename: Janusz K
authors.initials: JK
authors.lastname: Rybakowski
mesh_terms: D000328:Adult; D000368:Aged; D017109:Akathisia, Drug-Induced; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D003693:Delirium / Q000139:chemically induced*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy*; D017277:Drug Approval; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction / Q000379:methods; D013841:Thiazepines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States
chemical_list: D000929:Antidepressive Agents, Tricyclic; D013841:Thiazepines; C050504:tianeptine