Tetracyclic Antidepressants (TeCA)
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Overview
Tetracyclic antidepressants are a class of medications structurally related to tricyclic antidepressants but with a four-ring chemical structure. They work primarily by blocking alpha-2 adrenergic autoreceptors and heteroreceptors, increasing norepinephrine and serotonin release. Mirtazapine is the most commonly prescribed tetracyclic antidepressant.
How do tetracyclic antidepressants (teca) work?
Tetracyclic antidepressants like mirtazapine act as noradrenergic and specific serotonergic antidepressants (NaSSAs). They block presynaptic alpha-2 adrenergic receptors, enhancing norepinephrine and serotonin release. They also block 5-HT2A, 5-HT2C, and 5-HT3 receptors, which reduces sexual side effects and nausea compared to SSRIs. Strong H1 histamine receptor antagonism accounts for sedation and appetite-stimulating effects.
Drugs in this class
- Mirtazapine (Remeron, Remeron SolTab)