Tetracyclic antidepressants (TeCAs) are a class of antidepressants that were first introduced in the 1970s. They are named after their tetracyclic chemical structure, containing four rings of atoms, and are closely related to the tricyclic antidepressants (TCAs), which contain three rings of atoms.
Maprotiline (Ludiomil) – can also be classified as a TCA and grouped with the secondary amines
Mianserin (Tolvon)
Mirtazapine (Remeron)
Setiptiline (Tecipul)
Drugs that contain four rings not all fused together but are sometimes still classified as TeCAs include:
Amoxapine (Asendin) – often classified as a TCA and grouped with the secondary amines
Quetiapine (Seroquel) - an atypical antipsychotic sometimes used as an adjunct antidepressant
Benzoctamine (Tacitin) – a tetracyclic compound and is closely related to maprotiline, with the two compounds differing only in the length of their side chain, but benzoctamine is not used as an antidepressant and is instead used as an anxiolytic
Loxapine (Adasuve, Loxitane) – a typical antipsychotic that produces amoxapine as a major metabolite and is said to have antidepressant effects, but it is not usually regarded as a TeCA
Drugs that contain four rings not all fused together but could still be classified as tetracyclic include:
Mazindol (Mazanor, Sanorex) – a monoamine reuptake inhibitor used as an appetite suppressant and with potential antidepressant effects, but not classified as a TeCA
Aptazapine (CGS-7525A) – a close analogue of mirtazapine
Esmirtazapine (ORG-50,081) – the (S)-(+) enantiomer of mirtazapine
Oxaprotiline (C 49-802 BDA) – a close analogue of maprotiline
Drugs that contain four rings not all fused together but could still be classified as tetracyclic include:
Ciclazindol (WY-23,409) – a close analogue of mazindol
Pharmacology of antidepressants
TeCAs have diverse pharmacology and differ from TCAs in a number of ways. With the exception of amoxapine, TeCAs do not inhibit the reuptake of serotonin. However, aside from mirtazapine, they do inhibit the reuptake of norepinephrine.
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Mirtazapine, sold under the brand name Remeron amongst others, is an atypical tetracyclic antidepressant, and as such is used primarily to treat depression. Its effects may take up to four weeks, but can also manifest as early as one to two weeks. It is often used in cases of depression complicated by anxiety or insomnia. The effectiveness of mirtazapine is comparable to other commonly prescribed antidepressants. It is taken by mouth. Common side effects include sleepiness, dizziness, increased appetite and weight gain.
Cytochrome P450 2D6 (CYP2D6) is an enzyme that in humans is encoded by the CYP2D6 gene. CYP2D6 is primarily expressed in the liver. It is also highly expressed in areas of the central nervous system, including the substantia nigra. CYP2D6, a member of the cytochrome P450 mixed-function oxidase system, is one of the most important enzymes involved in the metabolism of xenobiotics in the body.
Mianserin, sold under the brand name Tolvon among others, is an atypical antidepressant that is used primarily in the treatment of depression in Europe and elsewhere in the world. It is a tetracyclic antidepressant (TeCA). Mianserin is closely related to mirtazapine, both chemically and in terms of its actions and effects, although there are significant differences between the two drugs. Mianserin at higher doses (30–90mg/day) is used for the treatment of major depressive disorder.
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