Low-Dose Acetazolamide in the Treatment of Premenstrual Dysphoric Disorder: A Case Series
A 39-year-old, single, nulliparous Caucasian woman, with cyclothymic/anxious temperament, suffered from severe PMDD since the age of 12. The premenstrual syndrome consisted in depressed mood, anxiety, difficulty in concentrating, and decreased interest in usually pleasurable daily activities.\nAt age 30, she began suffering from episodes of tachycardia, sweating, tremors, feelings of choking, and wheezing. Symptoms recurred frequently through the following years, forcing her to ask for a companion when she had to leave home or for activities like driving a car. This led to impaired social and working life. She received a diagnosis of DSM-IV panic disorder with agoraphobia. She tried several antidepressants, with no apparent benefit. When she came to our attention, we introduced 200 mg/day gabapentin and 0.5 mg/day clonazepam, while gradually discontinuing the SSRI antidepressant she was taking. Frequency and intensity of panic attacks diminished, to disappear completely after four months. Nevertheless, according to the daily diary, symptoms beginning typically few days after ovulation and ending with onset of menses remained unchanged (CGIs, 6). Hence we added during the luteal phase, i.e., 10 days before menses, 125 mg/day acetazolamide. The following month premenstrual symptoms improved (CGIs, 2) and completely disappeared after three months of treatment. She reported no side effects. More than one year after the introduction of add-on acetazolamide, the patient is premenstrual symptom-free (CGIs, 1).