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Side Effects of
Tetracyclic Antidepressants


Home>Side Effects>Tetracyclic Antidepressants

Description: Tetracyclic antidepressants are described by their chemical type, and contain four cyclic rings as part of their structure. Tetracyclic antidepressants are not as familiar to the similar tricyclic antidepressants but act similarly to elevate mood by inhibiting reuptake of neurotransmitters serotonin and/or noradrenaline in the brain. They are effective antidepressants but have a negative side effect profile so that they are used less often now. Both mirtazapine (Remeron) and maprotiline (Ludiomil) are in this class of antidepressants and are used to treat major depressive disorder (MDD), and both are tested as part of the Rxight® panel. (International Journal of Clinical Psychopharmacology “The effects of mirtazapine on central noradrenergic and serotonergic neurotransmission,” Dec 1995).


Since the tetracyclic antidepressants act similarly to other antidepressants, your physician may try one of these drugs if your current antidepressant isn’t working well for you. It is prescribed for major depressive disorder, otherwise known as clinical depression. As is the case with all FDA approved medicines, the efficacy of Remeron in obtaining and maintaining a response in patients with major depressive disorder (for up to 40 weeks following 8 to 12 weeks of initial open-label treatment) was demonstrated in a placebo controlled trial. Nevertheless, if your physician elects to use Remeron for extended periods she should periodically re-evaluate the long-term usefulness of the drug. Off-label uses of the both drugs include treatment for panic disorder, PTSD, generalized anxiety disorder, and OCD, and neuropathic pain. Source: The Primary Care Companion for CNS Disorders “A review of therapeutic uses of mirtazapine in psychiatric and medical conditions” (Oct 2013).

Serious Side Effects

As reported in various trials, there are incidences of serious side effects in Remeron, which are typical of all tetracyclics, such as:

  • Hypertension
  • Vomiting, anorexia
  • Myasthenia
  • Arthralgia
  • Pruritus
  • Urinary tract infection
  • Common Side Effects

    The most common side effects include:

  • Somnolence
  • Increased appetite
  • Weight gain
  • Dizziness
  • Less Common Side Effects

    Less common side effects include:

  • Abnormal dreams
  • Tremor
  • Confusion
  • Dyspnea
  • Urinary frequency
  • Source: Remeron Medication Guide, as reported by the U.S. Food and Drug Administration

    Understand Your Risks with the Rxight® Genetic Test

    With the advances in pharmacogenetics, the Rxight® test from MD Labs has been developed to assess your susceptibility to a number of different kinds of adverse events when taking TCAs such as Remeron and over 200 other OTC and prescription clinically relevant drugs on the market. This is possible because a limited set of enzymes are responsible for metabolizing any drug you may take. These gene products vary widely because the actual genetic code varies widely among populations. The field of pharmacogenetics arose out of the human genome, and is a set of groundbreaking advances in personalized medicine that can actually be applied to your personal care. Ask your physician today for the Rxight® pharmacogenetics test from MD Labs. It is a state of the art method to simultaneously test virtually all of your drug metabolism molecular machinery, giving you and your physician lifetime information and potential advice about what medicines you may take safely, what medicine dosages should be changed, and what medicines you should avoid.

    Contributors to this Article:
    Michael Sapko, MD, PhD; Deborah Kallick, PhD, Medicinal Chemistry

    Tetracyclic Antidepressants Tested Include:

    • Maprotiline (Ludiomil)
    • Mirtazapine (Remeron)

    Read more about Rxight® Genetic Testing For Depression Medication