Reports of significant changes in water and electrolytes during recovery from depression may provide insight into important physiological factors in depressive illnesses. Brown et al. (1963) demonstrated an increase in the extracellular fluid volume in 22 of 28 patients suffering from primary depressive disorders treated with E.C.T. or imipramine. The findings of these authors, which were discussed in relation to previous work on sodium metabolism and water balance in depressive disorders, were thought to support the idea of a shift of fluid from intracellular to extracellular spaces during the response to treatment. Coppen and Shaw (1963) found an increase in total body water, extracellular fluid and a decrease in the residual sodium space on recovery from depression.

Many instances of regular cyclic or periodic psychiatric and clinical syndromes have been reported (Richter, 1957). The duration of each cycle varies from 2 days to 18 months but is usually constant in a given subject and bears no relationship to external factors. Presumably they have their origin within the body, and a disturbance of endocrine function has been suggested in many cases. Some women show cycles corresponding to the menstrual rhythm, the abnormal phase preceding or accompanying the menstrual flow.

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Most of the water and electrolyte studies in mental illness have been carried out on patients suffering from periodic disorders and have been reviewed by Crammer (1962). Coppen and Shaw (1963) found increases in total body water and extracellular fluid and a decrease in residual sodium space on recovery from depression. Manic patients with a high vocal productivity were found by Anderson et al. (1964) to have a negative sodium balance, low plasma potassium levels and a positive potassium balance. Depressed patients with a low vocal productivity had a reduced rate of sodium loss and higher plasma potassium levels. Dawson et al. (1956) found extracellular expansion on spontaneous recovery from manic or depressive attacks. The purpose of the present study was to investigate variations in total body water and its distribution in manic-depressive psychosis. The investigation was complementary to a similar study of variations in body composition during recovery from depression reported by Hullin et al. (1967).