Low-Dose Acetazolamide in the Treatment of Premenstrual Dysphoric Disorder: A Case Series
A 30-year-old, single, nulliparous Caucasian woman with hyperthymic premorbid temperament and DSM-IV-TR recurrent major depressive disorder since age 20, had PMDD preceding her mood disorder by two years. A total of four depressive episodes occurred in ten years; these were characterized by depressive mood, initial insomnia, restlessness, and anxiety, but also by mixed features, such as racing and crowded thoughts, increased energy level, goal directedness, and inner tension. She had received trials with selective serotonin reuptake inhibitors (SSRIs).\nWe treated her for her mood disorder with oral amitriptyline, 50 mg/day, and oxcarbazepine, titrated to 600 mg/day. After three months of treatment, her mood stabilized. During the pre-menstrual period, however, she continued to experience low mood, hypersomnia, fatigue, anxiety, irritability, feeling of being overwhelmed, and concentration difficulties (CGIs, 5). We added acetazolamide 125 mg/day, for ten days before menses. After the first month of treatment, PMDD improved, resolving completely by the second month of treatment (CGIs, 1). No side effects occurred. After one-and-a-half year of add-on acetazolamide the patient has no premenstrual symptoms (CGIs=1).