Low-Dose Acetazolamide in the Treatment of Premenstrual Dysphoric Disorder: A Case Series
A 43-year-old, single, nulliparous Caucasian woman with a premorbid cyclothymic temperament developed since early adulthood intermittent periods of unpredictable mood fluctuations, causing her problems in her personal and professional life and leading to severe impairment of the social and work domains. She received DSM-IV-TR diagnosis of Cyclothymic Disorder. Her PMDD had its onset at early puberty, with depressive mood, inner tension, affective lability, decreased interest in usually pleasurable activities, irritability, and sense of being out of control. Symptoms occurred during the luteal phase, some days after ovulation, and ended few days after onset of menses. She described this intense and painful state as "the worst pain ever experienced".\nShe received gabapentin 600 mg/day. The amplitude of mood swings diminished from the first month, with mood reaching stabilization after five months of treatment. Nevertheless, the diary completed during follow-up showed that treatment was ineffective in reducing the luteal phase symptoms (CGIs, 7). Premenstrual symptom persistence for more than two consecutive cycles allowed us to diagnose PMDD. We added 125 mg/day acetazolamide during the critical days. Symptoms improved quickly during the next month (CGIs, 2), leading to complete remission within three months. No side effects were reported whatsoever, and the patient is still asymptomatic after twelve months of add on acetazolamide (CGIs=1).