NiHowdy > Drug Classes > Tetracyclic Antidepressants

Browse Medications by Drug Class: Tetracyclic Antidepressants

Written by Amar Lunagaria

Pharm.D • NiHowdy Founder

Reviewed by James Wong

Pharm.D • NiHowdy Founder

Published Jan 15, 2025

Fact checked

What are Tetracyclic Antidepressants?

Tetracyclic antidepressants (TeCAs) are a class of medications used to treat depression and related mood disorders by modulating the activity of neurotransmitters in the brain. They work primarily by increasing the levels of norepinephrine and serotonin, essential chemicals that regulate mood and emotional stability. TeCAs are particularly useful in cases of depression where other medications, such as SSRIs, have proven less effective. A unique feature of TeCAs is their sedative properties, making them beneficial for individuals with depression accompanied by insomnia or anxiety. NiHowdy ensures affordable access to these therapies, helping patients achieve emotional well-being.

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List of drugs in Tetracyclic Antidepressants

Drug Name	More Information	NiHowdy Prices & Bitcoin Rebate

Mirtazapine	Mirtazapine Information	Mirtazapine Pricing
Remeron	Remeron Information	Remeron Pricing
Remeron SolTab	Remeron SolTab Information	Remeron SolTab Pricing

Brief history about Tetracyclic Antidepressants?

Tetracyclic antidepressants were developed in the 1970s as an evolution of tricyclic antidepressants (TCAs). Maprotiline, one of the first TeCAs, offered similar efficacy to TCAs but with a slightly improved safety profile. Over time, other medications like mirtazapine expanded the therapeutic applications of TeCAs, particularly for patients with treatment-resistant depression or insomnia. While newer antidepressants have largely replaced TeCAs as first-line treatments, these medications remain valuable for specific patient populations. NiHowdy simplifies access to these cost-effective therapies, ensuring affordability for patients managing complex mood disorders.

How do Tetracyclic Antidepressants work?

TeCAs work by inhibiting the reuptake of norepinephrine and, to a lesser extent, serotonin, increasing the levels of these neurotransmitters in the brain. This enhances mood regulation and reduces symptoms of depression. Additionally, TeCAs like mirtazapine block specific serotonin and histamine receptors, providing anxiolytic and sedative effects. For instance, mirtazapine is particularly effective in treating depression with co-occurring insomnia, as it promotes better sleep while improving mood. NiHowdy ensures patients can access these targeted therapies affordably, empowering them to manage their mental health effectively.

What are Tetracyclic Antidepressants used to treat?

Depression

TeCAs are effective in treating major depressive disorder by enhancing norepinephrine and serotonin activity. Medications like mirtazapine are particularly beneficial for patients with melancholic depression or those who do not respond well to first-line treatments like SSRIs or SNRIs.

Anxiety

TeCAs, such as mirtazapine, are used to manage generalized anxiety disorder (GAD) and social anxiety disorder (SAD). By modulating serotonin and norepinephrine activity, these medications reduce excessive worry and physical symptoms of anxiety, promoting emotional stability.

Insomnia

Due to their sedative properties, TeCAs like mirtazapine are effective in treating insomnia that often accompanies depression. These medications help patients achieve restful sleep while addressing depressive symptoms, improving overall quality of life.

Post-Traumatic Stress Disorder (PTSD)

TeCAs may be used off-label for PTSD, alleviating symptoms such as hypervigilance, nightmares, and emotional distress. Their dual effects on mood and sleep make them suitable for patients with co-occurring depression and PTSD.

Who should consider Tetracyclic Antidepressants medications?

Adults

Adults with treatment-resistant depression, anxiety disorders, or depression accompanied by insomnia are ideal candidates for TeCAs. These medications provide comprehensive symptom relief and improve overall quality of life. Healthcare providers tailor treatment to individual needs, ensuring optimal outcomes.

Children

TeCAs are rarely used in pediatric populations but may be considered in specific cases of severe depression or anxiety where other treatments are ineffective. Doses are carefully adjusted, and close monitoring ensures safety and effectiveness in younger patients.

Seniors

Seniors with depression and insomnia may benefit from TeCAs, particularly due to their sedative properties. However, age-related changes in metabolism and the risk of side effects, such as sedation or dizziness, require careful dosing and regular monitoring.

Are Tetracyclic Antidepressants safe?

Tetracyclic antidepressants are generally safe when used as prescribed. Common side effects include drowsiness, dry mouth, and increased appetite, which are usually mild and manageable. Rare but serious risks include sedation-related falls in seniors or serotonin syndrome when combined with other serotonergic medications. Regular monitoring and adherence to prescribed regimens ensure the safe use of TeCAs.

Can I take Tetracyclic Antidepressants during pregnancy?

The safety of TeCAs during pregnancy depends on the specific medication and the patient's condition. While not typically first-line therapy, some TeCAs may be used if the benefits outweigh the risks. Pregnant individuals should consult their healthcare provider to determine the best treatment options.

Are Tetracyclic Antidepressants safe to take while lactating?

The safety of TeCAs during breastfeeding varies by medication. Some may pass into breast milk in small amounts and require careful consideration by a healthcare provider to ensure safety for both the parent and child.

Are Tetracyclic Antidepressants controlled substances?

TeCAs are not classified as controlled substances. They are available by prescription for managing depression, anxiety, and related conditions. Regular follow-ups with healthcare providers ensure proper use and monitoring.

Side effects of Tetracyclic Antidepressants?

Tetracyclic antidepressants are effective but may cause side effects. Common side effects include drowsiness, increased appetite, dry mouth, and weight gain. These symptoms are generally mild and improve as the body adjusts to the medication. Patients are encouraged to adopt a balanced diet and maintain hydration to mitigate these effects. Less common side effects include dizziness, constipation, and mild confusion, particularly in older adults. Dose adjustments or supportive care may alleviate these symptoms. Rare but serious side effects include serotonin syndrome, characterized by symptoms like agitation, rapid heart rate, and high fever, especially when combined with other serotonergic drugs. Patients should seek immediate medical attention if these symptoms occur. Healthcare providers recommend starting with a low dose and gradually increasing it to minimize side effects. Regular follow-ups ensure that the medication is effective and that any adverse effects are addressed promptly.

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Cost considerations and insurance coverage for Tetracyclic Antidepressants

Tetracyclic antidepressants are available as affordable generics, such as mirtazapine, making them cost-effective options for managing depression and related conditions. Most insurance plans cover these medications for approved indications. NiHowdy offers discounts, rebates, and Bitcoin rewards to further reduce costs, ensuring access to these essential treatments.

How do I get rebates on Tetracyclic Antidepressants?

NiHowdy's Bitcoin rebate program for TeCAs provides patients with a unique opportunity to save on healthcare costs while earning potential financial growth. This innovative approach makes managing depression and anxiety both affordable and rewarding, ensuring access to effective treatments while building long-term value.