Low-Dose Acetazolamide in the Treatment of Premenstrual Dysphoric Disorder: A Case Series
A 29-year-old, single, nulliparous Caucasian woman with cyclothymic premorbid temperament and DSM-IV-TR diagnosis of Bipolar Disorder, type II, had severe PMDD since her teens. The bipolar onset may be traced back to age 15, when she had a first depressive episode. Since then, she had four depressive and three hypomanic episodes. She took several antidepressant drugs with little benefit.\nSince the onset of PMDD, she had developed feelings of worthlessness and emptiness, a bleak outlook of future, and an imminent sense of death.\nWe treated her bipolar disorder with lithium up to 450 mg/day (lithium blood levels, up to 0.7 mEq/L) and oxcarbazepine up to 600 mg/day. Her mood stabilized after four months of treatment. Nevertheless, as emerging from the daily diary, important PMDD symptoms persisted. During the late luteal phase of the menstrual cycle, she was profoundly depressive, hopeless, hypersensitive and emotional, irritable, and unable to make any plan for the future (CGIs, 6). Acetazolamide 125 mg/day was added. The patient took the medication monthly for a 10-day period before menses. PMDD symptoms subsided soon (CGIs, 1). After three months of treatment, the patient stated she was living one more week per month compared to before. No side effects emerged. Improvement still persists at the 12-month follow-up.