Tetracyclic Compounds – An Antedepressant Agent

Type of Drug:

Antidepressant; mood-elevating agent.

How the Drug Works:

The exact mechanism of action is not known. It is believed that tetracyclic antidepressants adjust or balance how the brain and nervous system produce and respond to natural chemicals (neurotransmitters) that elevate mood.


Maprotiline: To treat depressive illness in patients with depressive neurosis (dysthymic disorder) and manic-depressive illness (major depressive episode).

Mirtazapine: To treat depression.

Unlabeled Uses: Maprotiline is also effective for the relief of anxiety associated with depression.


Do not use in the following situations:

Aallergy to the tetracyclic compound or any of its ingredients electroshock therapy, concurrent (maprotiline only)

Seizures: Maprotiline use has been associated with seizures. The risk is higher in patients with a history of seizures, in patients taking phenothiazines (eg, promethazine), or when benzodiazepines (eg, alprazolam) are being withdrawn.

Pregnancy: There are no adequate or well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: Maprotiline appears in breast milk. It is not known if mirtazapine appears in breast milk. Consult your doctor before you begin breast­feeding.

Children: Safety and effectiveness in children (younger than 18 years of age for maprotiline) have not been established.

Elderly: The elimination of mirtazapine is reduced in elderly patients. In general, lower doses of maprotiline are recommended for patients older than 60 years of age. Use with caution in elderly patients.

Lab Tests: Lab test may be required periodically during treatment. Lab tests may include blood counts and enzyme levels.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or are planning to take any over-the-counter or prescription medications or dietary supplements while taking a tetracyclic compound. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with tetracyclic compounds:

  • Alcohol
  • Barbiturates (eg, phenobarbital)
  • Benzodiazepines (eg, alprazolam)
  • MAOI antidepressants (eg, phenelzine)
  • phenothiazines (eg, promethazine)

Side Effects:

Every drug is capable of producing side effects. Many tetracyclic com­pound users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; vomiting; constipation; dry mouth; thirst; increased appetite; stomach pain; indigestion.

Nervous System: Confusion; anxiety; agitation; abnormal thinking; nervous­ness; tremor; twitching; drowsiness; clumsiness; dizziness; vertigo (feeling of whirling motion); weakness; fatigue; tiredness; sleeplessness; headache; abnormal dreams; increased sensitivity; apathy; depression; memory loss; numbness or tingling in the hands or feet.

Respiratory System: Difficulty breathing; cough; sinus problems: wheezing.

Circulatory System: Rapid heart rate; irregular heartbeat; increased cholesterol and triglyceride levels; increased blood pressure; low blood pressure on arising.

Skin: Rash; itching; hives; acne; dry skin; flushing; redness; hair loss. Other: Flu syndrome; general body discomfort; swelling in the hands or feet; blurred vision; muscle, joint, or back pain; frequent urination; urinary tract infection.

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