We prefer SSRIs and SNRIs in the U.S. Tianeptine is a
mu-opioid agonist, which makes it "controversial" for depression treatment. 8)
Before we knew how it worked, it was assumed to be an SSRE, or Selective Serotonin Reuptake
Enhancer. Meaning it enhances the reuptake of serotonin from the synapse, the opposite of what SSRIs do. That goes against the established dogma that depression is caused by lack of available serotonin. Or something to that effect.
I used tianeptine extensively during benzo withdrawal and found it very helpful for getting my moods out of the doldrums. Some people are abusing it in enormous amounts, but that seems ill-advised since it is
hepatotoxic in large doses...or sometimes normal ones. (Which is one reason its cousin amineptine was removed from the market). It's also highly inconvenient to dose since it's so short-acting.
The typical dose of the sodium is 12.5mg 3x per day, but I prefer to take 34mg of the sulfate in the morning followed by 15mg of the sodium in the afternoon and a booster of the sulfate again in the evening (27mg). The sulfate version lasts longer and has a smoother comedown, eliminating the need to redose constantly. But the sodium is more energizing and better for workouts and getting things done. There are no major interactions with other drugs that I'm aware of, as it's not a typical antidepressant but an opiate.
If you're looking for an opiate high, tianeptine is a poor candidate. It's an effective mood brightener if you have depression though.
