Tianeptine is prescribed as an antidepresant in Europe. The prescription drug is produced as tianeptine sodium. However, it can also be found on the Internet as tianeptine sulfate sold as a nootropric. Misuse of tianeptine sodium has been documented, but there’s little scientific evidence of tianeptine sulfate use.

Review the use of tianeptine sulfate without prescription.

Present a clinical report of tianeptine sulfate use.

PubMed review of tienptine use without prescription.

Clinical report of a patient using tianeptine sulfate adquiered on the Internet.

Systematic review on PubMed using the search term “tianeptine abuse” conducted on 01/10/2022. A total of 71 articles were found from wich 33 mentioned the use of tianeptine use without prescription. A total of 23 case reports of tianeptine use without prescription were found. None of them made the difference between tiaenptine sodium or tianeptine sulfate. Only one article mentioned the use of tianeptine sulfate from an Internet search on Internet fora (Smith et al. Am J Drug Alcohol Abuse 2021 47(4), 455–466).

The case report of a 23 years old patient is presented. Diagnoses: ADHD (F98.8); Psychotic episodes four (F23) and two (F16.150) years ago; Major depressive disorder (F32.2). Use of psychedelics, cannabis, psychoestimulants and opioids meeting substance use disorder (SUD) criteria. The patient brought proof of the tianeptine sulfate bought on the Internet (image 1) for self-treatment of his depressive symptoms. Tianeptine sodium is prescribed. The patient then restarts opioid use with fear of a new opioid use disorder episode and an oxicodone prescription is maintained. The patient then interrupts the antipsychotic medication and suffers a psychotic relapse. After this psychotic episode a LAI treatment with paliperidone is started. Currently, the patient is recovered and maintains psychopathological stability and abstinence from other substances. Blod test result unaltered. Current treatment: lisdexamphetamine 70mg /day, tianeptina sodium 12.5mg/day; oxicodone 40mg/12h and paliperidone 150mg /28d.

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Tianeptine sulfate is believed to present some diferences versus tianeptine sodium: it is sold only through the Internet without prescrption, the daily dose is 25mg per day versus 12.5mg every 8 hours and it might be more potent and long lasting. Those differences were confirmed by the patient after the prescription of tianeptine sodium.

Self-medication with psychoactive substances is one of the theories for substance use and might lead to a substance use disorder. This case shows how the prescription of a drug similar to the one used without presription might favour the therapeutical alliance and reduce the risk associated to the use of non-regulated substances.

Further research is needed to better understand the use of tianeptine sulfate.

None Declared

New Psychoactive Substances (NPS) appear to be increasing in popularity because they mimic the effect of traditional drugs. DOB is a world-wide controlled phenethylamine, with agonist activity in 5HT2A receptors. Its effects are comparable to those of LSD, with dosage range 1.0–3.0 mg and duration 18–30 h.

To assess the presence of DOB in the substances submitted to, and analyzed by, energy control.

All samples presented to Energy Control (EC) from August 2009 to August 2015 were analyzed. EC is a spanish harm-reduction non governmental organization that offers to users the possibility of analyzing the substances they intend to consume. Samples in which DOB was detected using gas chromatography-mass spectrometry were selected for this study.

From a total of 20,062 samples, 13 contained DOB (0,06%), with no clear variations among the years studied. The samples were mostly sold as DOC(8), DOB(2) and LSD(2). Nine out of total 13 samples presented as blotter.

Results suggest that availability of DOB in the Spanish drug market is anecdotic. Nonetheless, a number of the samples containing DOB were not sold as such, increasing the possibility of side effects, as users may ignore which substance they are actually using. When a patient presents at an Emergency Department with persistent hallucinogenic symptomatology after ingesting a blotter, psychiatrist should be aware of long-lasting psychedelics such as DOB.

The authors have not supplied their declaration of competing interest.

New psychoactive substances (NPS) are substances that have recently appeared on the market and are not under international control. NPS use is experiencing an unprecedented increase. DiPT, 4-HO-DiPT and 4-AcO-DiPT are new psychoactive tryptamines and their effects may differ from those of other psychoactive tryptamines.

To explore the presence of DiPT, 4-HO-DiPT and 4-AcO-DiPT from samples delivered to and analyzed by Spanish harm reduction service Energy Control.

All samples analyzed from 2009 to 2014 delivered as DiPT, 4-HO-DiPT and 4-AcO-DPT or containing these substances. Analysis was performed by gas chromatography–mass spectrometry.

From 17,432 samples, 4-HO-DiPT was found in 16, delivered as 4-HO-DiPT (6); 4-AcO-DiPT (7); DiPT (1); 4-AcO-DMT (1) and cocaine (1). 4-AcO-DiPT was found in 16, delivered as 4-AcO-DiPT (12); 5-MeO-DMT (1); 5-MeO-DiPT (1); 4-AcO-DMT (1) and cocaine (1). Only 4 samples contained DiPT, all presented as DiPT. Nine samples contained both 4-AcO-DiPT and 4-HO-DiPT. During the years of study, 4-HO-DiPT deliverance was increasing (4 samples in 2014) while deliverance of 4-AcO-DiPT and DiPT was decreasing (1 sample in 2014).

Increasing 4-HO-DiPT presence could translate a progressive replacement of 4-AcO-DiPT and DiPT recreational use. Clinical relevance comes from its growing use and the absence of scientific evidence on humans, therefore relying on users subjective experience to predict the effects.

The authors declare that they have no competing interest.

Depression is a disabling disorder with a high socio-economic impact. It might require hospitalization for symptom control and/or harm prevention. Other depressive disorders might as well require hospitalization in benefit of the patient. Hospitalization may be involuntary. Hospitalization willfulness in depressive patients has not been systematically studied in recent years.

The aim of this study is to explore the necessity of involuntary hospitalization in patients presenting depressive symptoms at the emergency service that were later diagnosed with a depressive disorder.

From all patients visited in the psychiatric emergency service from 2012 to April 2015 those that were hospitalized in the acute mental health unit and diagnosed with a depressive disorder were studied. All those monopolar depression diagnoses were considered, excluding those within the bipolar spectrum. Diagnosis followed CIE-9 criteria. A descriptive cross-sectional study of the samples was then conducted. Statistical analysis was performed using SPSS software (SPSS Inc., Chicago, Ill.).

From all 385 depressive disorders, 169 were involuntary admissions (43.9%), 196 were voluntary (50.9%) and 20 were scheduled (5.2%), difference was statistically significant (P < 0.05). Mean age, was 59.52 years for involuntary admissions, 61.7 for voluntary and 63.6 years for scheduled, with a statistically significant difference (P < 0.05). Gender differences were not significant.

Most depressive disorders were hospitalized voluntarily. However, a relevant percentage of patients required involuntary hospitalization. Younger patients presented a higher ratio of involuntary hospitalization. Reasons for involuntary hospitalization needs should be further studied.

The authors have not supplied their declaration of competing interest. Liliana Galindo is a Rio Hortega fellowship (ISC-III; CM14/00111).