Coaxil (tianeptine) is a somewhat controversial medication. Technically a tricyclic antidepressant, the medication deviates from other tricyclics to such an extent that it's not usually grouped with them.

An important distinction separating Coaxil from other antidepressants is how it handles serotonin; whereas most antidepressants---such as selective serotonin reuptake inhibitors (SSRIs) work to increase the amount of serotonin in the brain by inhibiting its reuptake, Coaxil actually decreases serotonin by encouraging reuptake---Coaxil is a selective serotonin reuptake enhancer, or SSRE.

Coaxil is also thought to improve neuroplasticity of the brain; it promotes the growth and branching of dendritic extensions of nerve cells while increasing the volume of the hippocampus. The medication also influences various chemicals other than serotonin in the brain.

Coaxil has numerous other properties that have caused its use to be expanded, usually off-label, to treat a variety of other conditions. Uses include:

• Depression
• Anxiety
• Asthma
• Attention deficit disorder
• Chronic pain
• Fibromyalgia
• Erectile dysfunction
• Panic disorder
• Parkinson's disease
• Post-traumatic stress disorder
• Irritable bowel syndrome

Coaxil may be used on its own or along with other medications, depending on what's being treated and its severity. The medication may also be used in other conditions not listed above as well.

For the most part Coaxil does not produce many of the concerning side effects associated with other antidepressants, notably those that affect the cardiovascular system. It also has a minimal sedative effect in most patients. There is, however, some research which suggests Coaxil may be more prone than most other antidepressants to cause liver damage.

Legality & Abuse

Coaxil is approved as an antidepressant in about 60 countries. In other countries---including the USA, Canada, and Australia---it ranges from "not approved" to outright illegal. "Not approved" in most cases means it can be purchased and sold but it's technically illegal to consume.

In many cases the medication is not approved simply because it hasn't been submitted to regulatory authorities for approval; in other cases, such as in the USA, development of the medication was ceased for unclear reasons.

In some areas Coaxil is illegal, largely because it is implicated in a handful of overdose deaths. Coaxil does see some abuse and is thought to be addictive at very high doses, though nowhere near as addictive as opioids. It is unlikely that Coaxil will be tested for unless there is some indication that the drug has been taken, but this might change if abuse becomes more widespread.

At very high doses Coaxil does produce euphoria, and patients withdrawing from Coaxil can feel unsettled, restless, and otherwise ill-at-ease, which can prompt additional use in an attempt to feel normal again. Use at the high doses needed to feel euphoric from this medication is not recommended; severe, and even fatal, side effects can happen.

Another form of abuse---though considerably less dangerous---is as a nootropic, or "smart drug." Some patients claim Coaxil increases clarity of mind and complex thought, while improving memory. This makes it a popular---though relatively hard to acquire---nootropic among college students and others who need sharp, focused minds.

Unlike many nootropics Coaxil does not promote wakefulness; though less of a sedative than many other antidepressants, it does still have a slight sedative effect.

Taking Coaxil

Coaxil comes in tablets, which should always be taken shortly before or during a meal. Treatment is typically remarkably similar in all non-abuse uses:

• Take 12.5 mg two or three times per day.
• Treatment should continue for as long as it provides benefit.

At the relatively low dose of 12.5 three times per day, tolerance is not a concern. There is also no need to worry about tapering off treatment if treatment should end, and the medication is very unlikely to be addictive at standard dosage levels.

Though some individuals notice differences right away, in most cases it takes a week or two of treatment before patients start feeling different. Provided no adverse effects develop, give the medication at least a couple of weeks before deciding it doesn't work.

For depression treatment often lasts 3 to 9 months, though this can vary to some extent. For other, off-label uses duration of treatment can vary quite a bit; a doctor can provide guidelines.

Side Effects

Taken as directed, side effects from Coaxil are rare and usually transient, meaning they stop occurring as the body adapts to the medication. Commonly reported are:

• Headache
• Dry mouth
• Constipation
• Drowsiness
• Insomnia
• Vivid dreams
• Dizziness

The above are not cause for concern unless persistant enough to be disruptive.

More severe side effects are rare but do happen, and are more likely when Coaxil is abused by taking very high doses regularly:

• Liver damage
• Severe fatigue
• Muscle aches
• Hard, rapid, or irregular heartbeats
• Blurred vision
• Tremor
• Euphoria

Coaxil can interact with numerous other medications, and monoamine oxidase inhibitors (MAOIs) should particularly be avoided for 14 days before or following treatment with Coaxil; mixing these medications can prove fatal. Always double-check with a doctor or pharmacist before taking any other medication with Coaxil.

Mothers who are pregnant or trying to become pregnant should not take Coaxil.