Modulation of atypical brain activation during executive functioning in autism: a pharmacological MRI study of tianeptine.
Robert H Wichers, James L Findon, Auke Jelsma and 10 others
PMID 33608048WHAT IT FOUND
A single dose of tianeptine shifted atypical brain activation in adults with autism towards typical patterns during attention tasks.
However, it did not improve actual test performance, so this is a proof of concept for brain changes, not evidence of clinical benefit.
Key findings
01Tianeptine abolished most brain activation differences between adults with autism and controls during response inhibition and sustained attention tasks, though performance on the tasks did not improve.
02In adults with autism, the degree of brain activation change after tianeptine correlated with the severity of repetitive behaviors, suggesting the drug affected networks linked to these symptoms.
03Tianeptine had opposite effects on brain activation in adults with autism compared to controls; it increased activation in some frontal regions in autism while decreasing it in controls.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
This was a small pilot study with only 19 participants in each group, and it was underpowered to detect behavioral performance differences. It tested only a single acute dose of tianeptine, so it cannot tell us if these brain changes persist with long-term treatment or if they lead to clinical improvement. The study included only male adults, so results may not generalize to women or children with autism. The primary outcome was brain activation (a biological marker), not functional improvement or symptom reduction, which are the outcomes that matter to patients and therapists. Tianeptine's mechanism is complex and may involve glutamate and opioid systems, not just serotonin, so the specific biological pathway responsible for the observed changes is unknown.
Declared interests
The study was funded by the EU-AIMS, AIMS-2-TRIALS, the NIHR Mental Health Biomedical Research Centre, and the Sackler Institute for Translational Neurodevelopment. No commercial pharmaceutical company is listed as a funder.
The easy way to misread this
Do not interpret the normalization of brain activation as evidence that tianeptine improves symptoms or functioning. The study found no significant improvement in task performance, and the participants received only a single dose. This is a proof-of-concept for a biological effect, not a demonstration of clinical efficacy.