Clinical and Neurobiological Effects of Tianeptine and Paroxetine in Major Depression
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are widely used as effective pharmacological agents to treat depressive disorders. In contrast to the SSRIs, which block the presynaptic serotonin (5-HT) transporter and by this route increase the concentration of serotonin in the synaptic cleft, the antidepressant tianeptine enhances the presynaptic neuronal reuptake of 5-HT and thus decreases serotonergic neurotransmission. Both SSRIs and tianeptine are clinically effective; however, their opposite modes of action challenge the prevailing concepts on the need of enhancement of serotonergic neurotransmission. To better understand the differences between these two opposite pharmacological modes of action, we compared the changes induced by tianeptine and paroxetine on psychopathology, the hypothalamic-pituitary-adrenocortical (HPA) system, and cognitive functions in a double-blind, randomized, controlled trial including 44 depressed inpatients over a period of 42 days. Depressive symptomatology significantly improved in all efficacy measures, with no significant differences between tianeptine and paroxetine. There was a trend toward better response to the SSRI among women. Assessment of the HPA system showed marked hyperactivity before the beginning of treatment, which then normalized in most of the patients, without significant differences between the two antidepressants. Cognitive assessments showed no significant differences between the two drugs investigated. The results of…
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Some included reports reported outcomes as interaction statistics without data on within-group changes from baseline and between-group differences at study end.
“Examples include outcomes reported as interaction statistics without data on within-group changes from baseline and between-group differences at study end24,27,51”
From Cognitive Effects of Pharmacotherapy for Major Depressive Disorder: A Systematic Review (2014) · cites this paper as [24]
Six reports stated or described analyses indicating that corrections for multiple comparisons were not made.
“6 reports24,25,30,31,41,55 stated or described the analyses in such a manner as to indicate that corrections were not made.”
From Cognitive Effects of Pharmacotherapy for Major Depressive Disorder: A Systematic Review (2014) · cites this paper as [24]
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- Authors
- Nickel, T., Sonntag, A., Schill, J., Zobel, A. W., Ackl, N., Brunnauer, A., Murck, H., Ising, M., Yassouridis, A., Steiger, A., Zihl, J., & Holsboer, F.
- Affiliations
- Max Planck Institute of Psychiatry (DE)
- Venue
- Journal of Clinical Psychopharmacology
- Published
- 2003-04
- Volume
- 23
- Issue
- 2
- Pages
- 155-168
- ISSN
- 0271-0749 (ISSN-L)
- OpenAlex
- W2085339275
- Cited by
- 152
- References
- 70
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 5 · 2022: 4 · 2021: 5 · 2020: 4 · 2019: 5 · 2018: 2 · 2017: 3 · 2016: 5 · 2015: 3 · 2014: 12 · 2013: 9 · 2012: 2
- FWCI
- 8.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Max Planck Institute for Plasma Physics (submittedVersion)
- Funders
- Servier
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- tianeptine, paroxetine, major depressive disorder, selective serotonin reuptake inhibitors, serotonin uptake, serotonergic neurotransmission, hypothalamic-pituitary-adrenal axis, cognitive function, antidepressant mechanism, inpatient depression
- MeSH terms
- Adult, Aged, Antidepressive Agents, Tricyclic, Cognition, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Psychiatric Status Rating Scales, Psychometrics, Task Performance and Analysis, Thiazepines, Treatment Outcome, Paroxetine, Antidepressive Agents, Second-Generation
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