Low-Dose Acetazolamide in the Treatment of Premenstrual Dysphoric Disorder: A Case Series
A 31-year-old, single, nulliparous Caucasian woman with cyclothymic premorbid temperament and DSM-IV-TR Bipolar Disorder, type II, had suffered from PMDD since her adolescence. PMDD was characterized by depressive mood, apathy, hypersomnia, anxiety, severe irritability and inner tension, impossibility to concentrate, fatigue, loss of interest in normal activities, crying, and severe binge eating. Her bipolar onset dates back to her twenties, when she presented with a first hypomanic episode. Since then, she had three depressive and four hypomanic episodes. She sporadically took antidepressant drugs.\nWe introduced lamotrigine up to 150 mg/day and immediate release quetiapine 100 mg/day to treat her mood disorder. Bipolar symptoms subsided after eight months of treatment, but PMDD persisted. On the diary, she reported that the above described picture of PMDD emerged during the pre-menstrual phase (CGIs, 5) and abruptly disappeared with menses. We added 125 mg/day acetazolamide. After the second month of treatment, PMDD started to improve, and had completely subsided by the fourth month of treatment (CGIs, 1). No side effects were reported.\nOne year later, the patient was fully asymptomatic. However, when she skipped acetazolamide one month, she re-experienced exactly the same PMDD syndrome as before. The next month, the patient reintroduced treatment, and this was followed by complete symptom resolution.