Tianeptine, also referred to under the brand names “Stablon” and “Coaxil,” is an antidepressant originally discovered and patented in the 1960s by the French Society of Medical Research.  The drug is primarily utilized for the treatment of major depressive disorder in France and European countries.  In some cases, tianeptine is also utilized for the management of additional medical conditions such as: anxiety disorders, asthma, and irritable bowel syndrome (IBS).

Compared to most antidepressants, tianeptine exhibits atypical pharmacodynamics involving: mu-opioid receptor (MOR) agonism; delta-opioid receptor agonism (DOR); mesolimbic dopamine release; D2 and D3 receptor potentiation; glutamate modulation (via AMPA and NMDA receptors); BDNF upregulation; and serotonin reuptake enhancement.  Though the structure of tianeptine is similar to tricyclic antidepressants (TCA), its mechanism of action is markedly different from most tricyclics.

While many individuals derive therapeutic benefit from using tianeptine to treat symptoms of mood disorders and other medical conditions, sometimes tianeptine loses its efficacy and/or becomes intolerable (due to side effects).  As a result, some tianeptine users will eventually opt to discontinue tianeptine treatment.  However, when tianeptine treatment is stopped, severe tianeptine withdrawal symptoms may emerge.

Tianeptine Withdrawal Symptoms (List of Possibilities)

Included below is a list of withdrawal symptoms that might occur after discontinuation of tianeptine.  Understand that the specific withdrawal symptoms you experience, the severities of those symptoms, and how long the symptoms last after completely stopping tianeptine – will be subject to individual variation.  In the event that you have questions about tianeptine withdrawal or the symptoms that you’re experiencing, contact a medical professional.

  • Allergy-like symptoms: Because tianeptine acts upon mu-opioid receptors, discontinuation of the medication can trigger allergy-like symptoms that are consistent with opioid withdrawal including: runny nose, watery eyes, sneezing, dry or scratchy throat, etc. If you feel like you’re developing an allergy after quitting tianeptine – it might just be the withdrawal.  Allergy-like symptoms in withdrawal may be partly related to fluctuations in histamine release.
  • Anxiety: Tianeptine is occasionally used to treat anxiety disorders in countries outside of the United States. Its action on the mu-opioid receptor downregulates CNS activity to promote mental and physical relaxation.  When the medication is discontinued, there’s often a rebound effect that occurs within the body characterized by increased production of stimulatory neurotransmitters and stress hormones – ultimately causing increased anxiety in withdrawal.
  • Appetite loss: It may be difficult to maintain much of an appetite in tianeptine withdrawal. Withdrawal symptoms like diarrhea, gastrointestinal distress, bloating, stomach aches, and nausea tend to decrease appetite.  If you find that your appetite is much lower than usual after quitting tianeptine, do your best to consume sufficient calories and/or foods to prevent vitamin, mineral, and electrolyte deficiencies.
  • Body aches: It is understood that tianeptine exerts an opioidergic effect that’s capable of alleviating symptoms of pain. However, when the medication is discontinued, endorphin production or signaling may be compromised, inflammation may be high, and stress hormone production may be elevated – each of which might cause body aches.  Body aches in withdrawal could also be due to dehydration and muscle tension.
  • Brain fog: After quitting tianeptine you may experience a constant “brain fog” or mental haze such that it becomes to think clearly or concentrate on important tasks. Brain fog in withdrawal may be accompanied by noticeable cognitive deficits (e.g. memory impairment) or depersonalization such that you feel like you’ve lost your personality or sense of self.  Assuming you didn’t have brain fog prior to using tianeptine, it should eventually dissipate in withdrawal.
  • Chills: Increased production of stress hormones coupled with neurotransmitter imbalances can sometimes affect body temperature in withdrawal. As a result of body temperature fluctuations, individuals may experience chills or sensations of coldness after quitting tianeptine.  These chills may be accompanied by sweating, fever, shivering, and/or goosebumps across the skin.
  • Cramping: Tianeptine withdrawal can sometimes trigger cramping. Cramping in withdrawal may be caused by dehydration, electrolyte or nutrient deficiencies, and/or increased muscle tension.  A combination of stress reduction, increasing water intake, massage, and consuming a nutritious diet may help alleviate withdrawal-related cramps.
  • Cravings: While most wouldn’t consider tianeptine to be as addictive as other opioids, it’s mechanism of action as a mu-opioid receptor agonist can make it an addictive substance. Specifically, tianeptine interacts with mu-opioid receptors which triggers downstream release of dopamine in the nucleus accumbens – causing users to experience a rewarding or pleasurable feeling.  When the medication is stopped, reward centers in the brain no longer receive the dopamine rush – which could lead the former user to crave tianeptine or other opioids.
  • Depression: Depression is a very common symptom of tianeptine withdrawal for a multitude of reasons. Persons who were using tianeptine to treat depression will no longer have tianeptine modulating neurochemistry to treat depressive symptoms – thereby leading a depressive relapse in withdrawal.  That said, tianeptine withdrawal may also cause depression as a result of neurotransmitter fluctuations, increased stress hormone production, sleep disturbances, and/or heightened anxiety.
  • Diarrhea: Treatment with tianeptine can cause constipation as a side effect as a result of peripheral mu-opioid receptor binding. When tianeptine is discontinued, peripheral mu-opioid receptors are temporarily underactive, thus allowing for quicker movement of food through the digestive tract.  Faster movement of food through the digestive tract can yield diarrhea or loose stools in withdrawal.
  • Dizziness: Withdrawing from tianeptine can yield a bit of dizziness or lightheadedness. The dizziness or lightheadedness is likely attributable to changes in neurochemistry throughout withdrawal.  However, things like electrolyte or nutrient deficiencies, dehydration, blood pressure changes, and unmanaged stress might also explain the dizziness in withdrawal.
  • Fatigue (low energy): Discontinuing tianeptine may cause fatigue or low energy. Fatigue as a withdrawal symptom might be partly caused by a resurgence of major depressive disorder or an anxiety disorder.  Still, things like suboptimal sleep, heightened stress response, circadian rhythm changes, and/or withdrawal-related neurochemical shifts could also explain fatigue after tianeptine cessation.
  • Fever: Some individuals may experience a mild fever while withdrawing from tianeptine. It is thought that thermoregulatory processes can become disrupted as a result of hormone and neurotransmitter fluctuations after the medication is stopped.  If you experience a fever in withdrawal, it’s most likely to be in the acute phase (or first 2 weeks) following discontinuation.
  • Flu-like symptoms: After discontinuing tianeptine, you may experience a myriad of symptoms that are analogous to those associated with the flu. Flu-like symptoms that might emerge after tianeptine treatment is ceased include: aches, chills, fever, headaches, nausea, sweats, stomach ache, vomiting, and diarrhea.  It may be helpful to use an over-the-counter medication like acetaminophen or NSAIDs to manage these symptoms.
  • Headaches: Headaches are one of the most common symptoms reported in tianeptine withdrawal. There are many possible reasons as to why an individual might end up with a headache after discontinuing tianeptine, including: neurotransmitter fluctuations, cerebral blood flow shifts, increased inflammation, dehydration, or electrolyte deficiencies.  Stress reduction, headache relief medications, adequate hydration, and electrolyte supplements may help with headaches in withdrawal.
  • Heart rate increase: Increased heart rate may occur in tianeptine withdrawal as a result of increased sympathetic tone – caused by increased action of stimulatory neurotransmitters throughout the central nervous system. If you have a medical history with cardiovascular events, it is recommended to have your heart regularly monitored throughout withdrawal.  A combination of stress reduction and anxiolytic medications may prove useful in normalizing the heart rhythms in withdrawal.
  • Insomnia: Insomnia and other sleep disturbances might emerge after quitting tianeptine. Increased production of stimulatory neurotransmitters can provoke rapid or racing thoughts in withdrawal, heightened anxiety, and agitation – each of which can interfere with the ability to fall or stay asleep.  Moreover, a return of depression after quitting tianeptine could also exacerbate sleep disturbances throughout withdrawal.
  • Irritability: Withdrawing from tianeptine may cause you to feel irritable or angry more frequently than usual. Irritability can be related to heightened stress, compromised sleep, and neurotransmitter dysregulation in withdrawal.  To manage the irritability, it is recommended that you work with a psychologist and find healthy ways to manage stress (e.g. exercise, meditation, etc.).
  • Nausea: Nausea after discontinuing tianeptine can be relatively severe. One possible way to cope with the nausea is to use over-the-counter antiemetic drugs.  Nevertheless, sometimes even antiemetics cannot fully manage nausea in withdrawal.  If the nausea becomes unmanageable, it could provoke vomiting.
  • Palpitations: Some people will report heart palpitations after ceasing tianeptine use. Heart palpitations are flutter-like sensations in which the heart rhythm or pattern is abnormal.  These palpitations are generally caused by changes in hormone signaling and neurotransmitters in withdrawal.  Stress management and anxiolytic medications might help reverse these palpitations.
  • Restlessness: It may seem difficult to sit still, remain calm, or physically relaxed in tianeptine withdrawal. The restlessness or restless leg syndrome (RLS) that occur might interfere with your sleep cycle or your productivity at work.  Reducing your anxiety level, anxiolytic medications, and/or engaging in light exercise might help with the restlessness in withdrawal.
  • Suicidal thoughts: A subset of individuals withdrawing from tianeptine may experience suicidal thoughts in withdrawal. The internal suicidal thoughts (e.g. “I want to die”) are likely caused by a combination of neurochemical imbalances, a return of depressive symptoms, and high stress in withdrawal.  Seek immediate medical attention and psychological therapy if you experience these thoughts in withdrawal.
  • Sweats: Sweating can be excessive after quitting tianeptine. Increased sweat production or hyperhidrosis is sometimes triggered by high stress and hormone shifts in withdrawal.  Because the sweats can cause dehydration and deplete electrolyte stores, it is recommended to rehydrate with water and replenish any lost electrolytes if you’re sweating profusely.
  • Stomach aches: Gastric distress can cause nausea, vomiting, diarrhea – and intense stomach aches after quitting tianeptine. Stomach aches may be accompanied by other symptoms such as bloating and flatulence.  If you have bad stomach aches after quitting tianeptine, refrain from consuming foods that irritate your GI tract – instead consume light foods in small quantities.
  • Tremor or shakiness: Involuntary movements, jitters, trembling, or shakiness may occur in tianeptine withdrawal. Tremor may be related to increased production of stimulatory neurotransmitters throughout the CNS – and the corresponding sympathetic stress response.  Relaxation exercises and anxiolytic medication may help get the shakes under control in withdrawal.
  • Vomiting: Tianeptine withdrawal can trigger severe nausea, sometimes so severe that it leads to vomiting. Because vomiting can cause dehydration, electrolyte imbalances, and/or nutrient deficiencies – it is recommended to replenish all lost water and calories in the aftermath of vomiting.  Using over-the-counter anti-emetic medications may help prevent vomiting in withdrawal.
  • Yawning: Withdrawal from tianeptine and other opioidergic drugs can cause frequent yawning. The exact reason yawning occurs while discontinuing opioids isn’t clear, however, it may simply be related to poor sleep or circadian rhythm changes.  Reducing your stress and enhancing your sleep might help reduce yawn frequency in withdrawal.

Note: The aforementioned list of tianeptine withdrawal symptoms might be incomplete.  If you happen to know additional symptoms that can occur following tianeptine discontinuation, report them in the comments section.

Factors that influence Tianeptine withdrawal symptoms

The severities of tianeptine discontinuation symptoms experienced by former users will be influenced by many variables.  Those who are familiar with tianeptine withdrawal believe that several variables such as: duration of tianeptine administration; tianeptine dosing; rate of tianeptine discontinuation; usage of other substances; lifestyle of the former tianeptine user; and gene expression – could impact the severities of symptoms associated with tianeptine discontinuation.

  1. Length of Tianeptine use

The cumulative duration over which you used tianeptine prior to discontinuation might influence the severity of withdrawal symptoms.  Individuals who used tianeptine for a short-term are thought to experience less severe withdrawals compared to those who used tianeptine for a long-term.

When tianeptine is used for a short-term (especially at a low dose), physiology will be modulated less significantly than if used for a long-term (especially at a high dose).  In brief, a short-term user’s physiology should have an easier time transitioning back to homeostasis than the long-term user’s physiology – making withdrawal more difficult for a long-term user.

  1. Tianeptine dosage

The dosage of tianeptine that a person administered throughout his/her treatment could impact withdrawal severity.  Usually, the higher the dosage of tianeptine used throughout treatment, the greater the severity of withdrawal symptoms that ensue upon cessation.

High doses of tianeptine exert more prominent or significant physiologic effects than low doses.  As a result of high-dose administration, physiology undergoes a more substantial shift away from homeostasis.  When a high-dose user discontinues treatment, it usually takes more time for the central nervous system to reestablish homeostasis.

  1. Rate of tianeptine discontinuation

The rate at which you discontinue tianeptine use could affect the difficulty of withdrawal.  It is understood that rapid withdrawal or “cold turkey” cessation of tianeptine tend to trigger harsher withdrawal symptoms than a gradual taper.  Tapering off of tianeptine helps guide the physiology of the former user back to homeostasis over a longer period of time – thus preventing severe withdrawal reactions.

Rapid cessation or cold turkey tianeptine withdrawal leaves the former user’s physiology in tianeptine-adapted state – without the presence of tianeptine.  As a result, neurotransmitter production, receptor sites, etc. – are all still expecting the presence of a regular tianeptine dose.  When the standard tianeptine dose is suddenly not delivered, it serves as a proverbial “shock” to the central nervous system – potentially causing harsh withdrawal reactions.

  1. Use of substances in tianeptine withdrawal

Using substances in tianeptine withdrawal such as: prescription medications, over-the-counter drugs, and/or dietary supplements – may affect withdrawal severity.  In most cases, withdrawal symptoms end up being easier to manage with physiologic support from other substances.

Oppositely, withdrawal symptoms tend to be more difficult to manage without any physiologic support among those who transition from tianeptine to a completely sober state.  For this reason, tianeptine withdrawal symptoms should be expected to be less severe among persons who have started using (or are still using) various medications, OTC drugs, or supplements after tianeptine cessation.

  1. Lifestyle & genetics

The lifestyle and genetics of a former tianeptine user could influence the severity of withdrawal symptoms – as well as how long it takes to recover from those symptoms.  Persons who put forth a conscious effort to maintain a healthy lifestyle throughout tianeptine withdrawal may find that symptoms: are less severe, are easier to manage, or subside at a quicker rate – than individuals who make no effort to stay healthy in withdrawal.

If you’re consuming a nutritious diet, exercising regularly, socializing with supportive family/friends, finding ways to reduce stress, and working with a psychologist – your withdrawal symptoms will probably be easier to handle than if you’re making unhealthy choices.  Eating junk food, staying sedentary, isolating yourself from others, and failing to manage your stress could exacerbate withdrawal symptoms.

It is also possible that gene and epigenetic expression could play roles as influencers of tianeptine withdrawal.  Expressing or lacking certain genes might enhance recovery from tianeptine withdrawal – compared to average.  On the other hand, expressing or lacking certain genes might also cause more difficult withdrawals – compared to average.

How long does Tianeptine withdrawal last? (Duration & Timeline)

Since the duration of tianeptine withdrawal will be subject to individual variation, there’s not a specific timeline that can be outlined to portray how long tianeptine withdrawal symptoms will last.  Nevertheless, because tianeptine functions predominantly as a mu-opioid receptor agonist, many believe the withdrawal timeline is analogous to that of other opioidergic drugs.  For this reason, tianeptine withdrawal may provoke acute withdrawal symptoms that are harshest within the first 72 hours of cessation – possibly remaining severe throughout the first 14 days of withdrawal.

For most individuals, the most debilitating acute symptoms of withdrawal should dissipate within the first 3 weeks of tianeptine discontinuation.  That said, after the acute phase of withdrawal, former tianeptine users often endure “post-acute withdrawal syndrome” or PAWS –characterized by additional withdrawal symptoms that persist for months after tianeptine treatment ends.  For certain people, the PAWS phase of withdrawal might last for 3-6 months, whereas for others it might persist for a longer duration.

The total time needed to recover from PAWS will likely be contingent upon tianeptine tolerance prior to discontinuation.  Someone who used a very high dose for a long-term may require more time to reach physiologic homeostasis after tianeptine cessation – than someone who used a low dose for a short-term.  To ensure that you recover from tianeptine withdrawal at the fastest possible rate – it is recommended to receive medical support.

How to minimize the severity of Tianeptine withdrawal symptoms

Assuming you want to recover from tianeptine withdrawal as rapidly as possible and prevent adverse withdrawal reactions, it is recommended that you consider the suggestions listed below.  Strategies for reducing the severity of tianeptine withdrawal might include: receiving assistance from a medical doctor; tapering off of tianeptine (instead of cold turkey discontinuation); using medications or supplements that a medical doctor thinks will help in withdrawal; working with a psychologist; and focusing on your general health.

  • Assistance from medical doctor: Medical doctors are trained to recognize and treat any adverse reactions that you might experience in tianeptine withdrawal. Additionally, medical doctors may be able to prescribe medications that help alleviate tianeptine withdrawal symptoms.  To overcome your symptoms as quickly as possible, regularly seeing a medical doctor is recommended.
  • Taper off of tianeptine: Tianeptine is medication with an extremely short half-life. Due to its short half-life, anyone who quits tianeptine “cold turkey” or too rapidly can end up with severe (possibly even dangerous) withdrawal symptoms.  Long-term tianeptine users may be best off conducting a slow taper in accordance with instruction from a medical doctor.  It has been suggested that tapering at a rate of 10% per month is often gradual enough to minimize withdrawal.
  • Medications & supplements: Medical doctors will be able to prescribe medications to help minimize the severity of tianeptine withdrawal symptoms and/or enhance your recovery. Moreover, medical doctors will be able to tell you whether certain supplements may be useful in tianeptine withdrawal.  Using medications and/or supplements in withdrawal as directed by your doctor will likely be helpful in recovery from symptoms.
  • Support from psychologist: If you were using tianeptine to treat a psychiatric condition or are experiencing psychiatric symptoms in withdrawal, it is strongly recommended that you receive support from a qualified psychologist. A psychologist will help provide much-needed psychological support in withdrawal and may teach you some ways to cope with your symptoms.
  • Focus on your heath: Assuming you’re trying to overcome tianeptine withdrawal symptoms as quickly and efficiently as possible, it is recommended to make your health a top priority. It may seem difficult to take care of yourself in withdrawal, but doing things like: eating a nutritious diet, getting adequate exercise, and keeping stress to a minimum – should augment your recovery efforts.

Best supplements to manage Tianeptine withdrawal symptoms

Included below is a list of supplements (and over-the-counter meds) that might be helpful while undergoing tianeptine withdrawal.  Understand that not all individuals will respond well to the substances listed below after tianeptine discontinuation.  For this reason, it is recommended to consult a medical doctor to verify that supplementation is safe and/or effective for you – throughout tianeptine withdrawal.

Affiliate link disclosure: The supplements listed above contain affiliate links which help mentalhealthdaily.com earn money.  If you want to support the site, buying products through affiliate links is appreciated.  I did my best to select products that I thought were reasonably priced and potentially therapeutic for persons experiencing tianeptine withdrawal.

  • Electrolyte formula: Withdrawal from drugs with an opioidergic effect can disrupt electrolyte levels within the body. To correct electrolyte imbalances in withdrawal and ensure that certain withdrawal symptoms aren’t directly attributable to low electrolytes – consider supplementing with a quality electrolyte formula.
  • Imodium: If you experience diarrhea after discontinuing tianeptine, you may want to consider using Imodium – an over-the-counter antidiarrheal medication. Imodium is also understood to help with bloating, stomach cramps, and other signs of gastrointestinal distress.
  • Magnesium citrate: Supplementing with magnesium citrate may help reduce muscle tension and increase physical relaxation throughout withdrawal. Some individuals may find that magnesium citrate works well for anxiety, headaches, insomnia, and restlessness.
  • Epsom salts: Adding Epsom salts to a warm bath might be just what’s needed to alleviate body aches, muscle cramps, or joint pain – throughout tianeptine withdrawal.
  • Glutathione: To help the body eliminate toxins and reduce oxidative stress after quitting tianeptine, you may want to supplement with glutathione.
  • Krill oil: Krill oil is a supplement that consists of omega-3 fatty acids in a format that is efficiently absorbed by the body. The omega-3 fatty acids in krill oil may help restore healthy brain function and promote healing after tianeptine cessation.
  • Low-dose melatonin: If you find yourself unable to sleep after quitting tianeptine, using low-dose melatonin before bed may help.
  • Multivitamin: There’s a chance that withdrawal from tianeptine may interfere with your body’s ability to absorb nutrients from food. To ensure that you maintain adequate vitamin levels during tianeptine withdrawal, consider supplementing with a multivitamin.
  • Probiotic: Supplementing with a quality probiotic in the later stages of withdrawal may help improve your gut health, as well as neurotransmission throughout the central nervous system.
  • B-complex: Using a vitamin B complex is certainly not necessary, however, vitamin B complex supplements may provide a bit of extra relaxation and help reduce restlessness after quitting tianeptine.
  • Curcumin: Certain individuals may end up with heightened inflammation after quitting tianeptine. Supplementing with curcumin might help reduce the inflammation and repair brain function in withdrawal.
  • L-Tryptophan: Tianeptine is a serotonin reuptake enhancer, meaning it appears to reduce serotonin signaling. Though there may be a rebound of serotonin after discontinuation, it may be useful to supplement with L-tryptophan to ensure that serotonin levels are adequate.
  • L-Tyrosine: Tianeptine affects mesolimbic dopamine release during treatment. To increase dopamine signaling after discontinuation of tianeptine, you may want to supplement with L-tyrosine.  L-tyrosine is a supplement that the body can use to synthesize dopamine.

Have you experienced Tianeptine withdrawal symptoms?

In the event that you recently stopped using tianeptine and are undergoing withdrawal, share a comment below about your tianeptine withdrawal experience.  By leaving a comment, you might help someone else who is either struggling through tianeptine withdrawal – or who feels alone in the withdrawal process.

To help others get a better understanding of your personal withdrawal experience, provide details in your comment such as: how long you used tianeptine before withdrawal; the tianeptine dose that you administered throughout treatment; and the specific purpose for which you used tianeptine in the first place.  Moreover, you may want to note things like: speed of tianeptine discontinuation (e.g. rapid taper, cold turkey, etc.); how long you’ve been off of it; and whether you’ve used other medications or supplements in withdrawal.

Were there any tactics or coping strategies that you implemented to aid in the management of tianeptine withdrawal symptoms.  Did you receive medical supervision and/or guidance in the withdrawal process – or did you discontinue tianeptine without medical assistance?  In your experience, what were the worst or most debilitating symptoms of tianeptine withdrawal?