Arginine vasopressin in manic-depressive psychosis

Urinary excretions of arginine vasopressin (AVP), sodium, potassium, osmoles and creatinine were measured in three in-patients with bipolar manic-depressive psychosis on at least eight 24-hour periods in each affective phase. Mood and body weight were recorded twice daily. The excretion by each patient of sodium, water and osmoles was greater in mania than during depression. Comparison of electrolytes and osmoles suggested that the increase was due to increased intake of salt and water rather than of total diet. There was a fall of mean AVP excretion during mania, the magnitude of the fall being related to the increase of water throughput. Compared with controls, AVP excretion was high and variable. It did not show the normal relationship to urine osmolality. Days with very high AVP were not associated with any characteristic feature of the other measurements; nor were they confined to any one point in the manic-depressive cycle. AVP does not appear to play a major role in the salt and water changes characteristic of manic-depressive psychosis and we have no evidence of its having any direct relationship to mood changes. We suggest that the observed abnormalities of AVP excretion are another manifestation of the central defect of this disease.