Tetracyclic Antidepressants

Tetracyclic antidepressants

Tetracyclics are an antidepressant type that relieves depression symptoms and boosts mood. Discover how they work and what side effects they may cause.
By Mayo Clinic staff

Certain brain chemicals called neurotransmitters are associated with depression, including the neurotransmitters serotonin (ser-oh-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin). Research suggests that abnormalities in neurotransmitter activity can affect mood and behavior.

How tetracyclic antidepressants work
Instead of inhibiting the reabsorption of certain neurotransmitters, as other antidepressants do, tetracyclic antidepressants prevent neurotransmitters from binding with nerve cell receptors called alpha-2 receptors. This indirectly increases the levels of norepinephrine and serotonin in the brain. In turn, that may improve and elevate mood.

Antidepressants, in general, may also work by playing a neuroprotective role in how they relieve anxiety and depression. It’s thought that antidepressants may increase the effects of brain receptors that help nerve cells keep sensitivity to glutamate — an organic compound of a nonessential amino acid — in check. This increased support of nerve cells lowers glutamate sensitivity, providing protection against the glutamate overwhelming and exciting key brain areas related to anxiety and depression.

Therapeutic effects of antidepressants may vary in people, due in part to each person’s genetic makeup. It’s thought that people’s sensitivity to antidepressant effects, especially selective serotonin reuptake inhibitor effects, can vary depending on:

* How each person’s serotonin reuptake receptor function works
* His or her alleles — the parts of chromosomes that determine inherited characteristics, such as height and hair color, which combine to make each person unique

Antidepressant medications are often the first treatment choice for adults with moderate or severe depression, sometimes along with psychotherapy. Although antidepressants may not cure depression, they can help you achieve remission — the disappearance or nearly complete reduction of depression symptoms.

Tetracyclic antidepressants approved to treat depression
Here’s the tetracyclic antidepressant approved by the Food and Drug Administration specifically to treat depression, with its generic, or chemical, name followed by available brand names in parentheses:
* Mirtazapine (Remeron, Remeron SolTab)

Side effects of tetracyclic antidepressants
Side effects of tetracyclic antidepressants include:
* Drowsiness
* Weight gain
* Dry mouth
* Dizziness
* Lightheadedness
* Thirst
* Muscle or joint aches
* Constipation
* Increased appetite
* Increased cholesterol

Safety concerns with tetracyclic antidepressants
Because of a potential drug interaction, don’t take mirtazapine with another type of antidepressant called a monoamine oxidase inhibitor (MAOI). You may have increased drowsiness if you take mirtazapine with other medications or substances that also cause drowsiness, such as antihistamines, sedatives or alcohol.

Rarely, mirtazapine can cause a potentially dangerous drop in white blood cell counts (agranulocytosis). This condition can make you vulnerable to infection. Talk to your doctor if you develop a sore throat, fever, inflammation of the mouth, flu-like symptoms or other signs of infection.

If you have phenylketonuria, tell your doctor before taking Remeron SolTab. The orally disintegrating tablet contains phenylalanine, an amino acid found in many high-protein foods, which is limited in the diets of those with phenylketonuria.

Suicidal feelings and tetracyclic antidepressants
In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior in those ages 18 to 24. These symptoms are likely to occur in the first one to two months of treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring when beginning or changing treatment, or you may need to stop the medication if your symptoms worsen. Adults age 65 and older taking antidepressants have a decreased risk of suicidal thoughts.

Talk with your doctor or mental health provider to nix your sadness, irritability or anger and improve your mood with tetracyclic antidepressants. Feel good again.


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