Lakes worldwide have been strongly affected by several types of human-caused alteration, including changes in water level. This also affects deep lakes, including volcanic ones. Volcanic lakes in the Mediterranean area are of great importance for the local economy, but local human activities can threaten their rich biodiversity. As a European biodiversity hotspot and habitat of endemic species, the volcanic Lake Bracciano (Central Italy) is an ecosystem of primary conservation interest threatened by sharply falling water levels, particularly since 2017. It also plays a key role in human wellbeing by providing important ecosystem services including drinking water, fisheries and various recreational opportunities. Although the lake has historically been considered to enjoy good ecological status, various environmental problems, often amplified by water level changes, have arisen during the last two decades. Given this recent rapid evolution, the lake can be considered an example of a valuable ecosystem at risk as a result of increasing anthropogenic pressures. The aim of this review is to examine the changes that have affected the lake in the last 20 years, considerably reducing its capacity to provide ecosystem services, and to review existing and potential threats in order to better inform the management of such resources.