Acetazolamide for Bipolar Disorders: A Scoping Review.

Area of Science:

• Pharmacology
• Neuroscience
• Psychiatry

Background:

• Bipolar disorder presents significant unmet treatment needs.
• Acetazolamide, a carbonic anhydrase inhibitor, is being explored for its potential therapeutic effects in bipolar disorder.

Purpose of the Study:

• To synthesize existing evidence on acetazolamide's effects on bipolar disorder symptoms.
• To evaluate the acceptability and tolerability of acetazolamide.
• To review intervention characteristics like dose and duration.

Main Methods:

• A scoping review of literature from Pubmed, Embase, and PsycInfo databases up to August 2022.
• Inclusion of five studies involving 50 patients, including open-label trials and case reports.
• Systematic data extraction focusing on treatment response, tolerability, and intervention details.

Main Results:

• Approximately 44% of patients showed a response to acetazolamide, irrespective of baseline episode type, dose, or duration.
• An additional 22% experienced minimal benefits.
• Acetazolamide was generally well-tolerated and acceptable for up to two years, though reporting was suboptimal.

Conclusions:

• The current evidence for acetazolamide in bipolar disorder is preliminary and limited by small sample sizes and methodological weaknesses.
• Findings are encouraging enough to warrant larger, randomized clinical trials.
• Significant uncertainty remains regarding acetazolamide's viability as a treatment for bipolar disorders.