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Tianeptine is a non-monoaminergic atypical antidepressant. It does not block serotonin, norepinephrine or dopamine re-uptake, bind to >100 classic receptors or inhibit MAO. Instead, it is a weak but functionally effective Mu- and Delta-opioid receptor agonist, that increases limbic dopamine, prevents morphine tolerance and has anti-inflammatory effects on microglia without opioid dependence.
Tianeptine regulates glutamate by normalising stress-induced overflow, up-regulating glial transporters, antagonising glycine-B site of NMDA receptors, and potentiating AMPA receptors to restore synaptic plasticity. Chronic treatment up-regulates BDNF, NGF and CREB, reverses dendritic atrophy, stimulates hippocampal neurogenesis and normalises mitochondrial respiratory-chain deficits/oxidative stress. It also normalises hyperactive HPA axis by decreasing ACTH/corticosterone and restoring glucocorticoid receptor sensitivity. These multiple actions combine to produce rapid antidepressant and anxiolytic effects, along with improving somatic and cognitive symptoms, with efficacy in SSRI-resistant, parkinsonian or PTSD depression without sedation or cardiovascular liability.
In conclusion, Tianeptine is a glutamate- and neuroplasticity-focused approach that can complement monoaminergic antidepressants.
Fig. 1 Mechanism of action of Tianeptine in treating antidepressant. (Alamo C.; et al. 2019)
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