Last Updated on March 8, 2023 by Mike Robinson

What is Potomania?

Potomania is an impulsive desire to drink water all the time and can have serious consequences. People suffering from it often drink between ten and fifteen liters of water daily. Potomania is also considered a disorder of impulse control characterized by excessive water intake. It frequently occurs in patients with schizophrenia or other chronic psychiatric illnesses.

But the good news is that this disorder is curable with proper treatment. To learn more about this condition, continue reading this article.

Causes of Potomania

Several factors, including the following, can cause potomania:

• Changes in the functioning of the hypothalamus:  The hypothalamus is a region of the brain responsible for regulating hunger and thirst, among other essential functions. An alteration in the functioning of this region could cause an episode of potomania.
• Underlying psychiatric diseases: Certain mental illnesses, such as schizophrenia, anxiety disorders, major depression, bipolar disorder, and delirious conditions, increase the risk of suffering from this condition.
• Certain diseases, such as diabetes, can cause a great sensation of thirst accompanied by excessive fluid intake.
• Some patients with anorexia nervosa can present with potomania: they often use water intake to satisfy themselves without contributing calories or to momentarily increase their body weight before going to a medical consultation, for example.
• Certain medications, such as nonsteroidal anti-inflammatory drugs and anticholinergic drugs, can also cause episodes of potomania.

When there is no organic cause for this condition, and the origin is strictly psychological or psychiatric, the situation is called psychogenic polydipsia.

Symptoms of Potomania

The main symptoms are the compulsive desire to drink water and the excessive intake of liquids, which exceeds four liters of water daily. If a person consumes more than six liters daily, they should consult a doctor immediately, even if there are no other symptoms.

In patients with potomania, there may also be a feeling of anxiety, problems sleeping, panic attacks, and headaches.

Dangers of Potomania

If treatment is not received, potomania can have severe consequences and even cause the patient’s death. When a person drinks too much liquid, the kidneys cannot eliminate the excess urine.

Therefore, the water dilutes the blood and lowers the concentrations of sodium, potassium, and chlorine, which are very important for body functioning. Approximately 10 to 20% of patients with potomania have low blood sodium levels.

This change in the concentration of ions in the blood can cause:

• Muscle cramps.
• Sickness.
• Headache.
• Swelling in the joints of the legs.
• Heart failure.
• Confusion, depression of consciousness
• Hallucinations
• Paralysis.
• Convulsions
• Coma.
• Death.

For this reason, it is imperative that any person who is drinking more than four liters of water daily consult the doctor immediately.

Treatments for Potomania

The treatment of potomania may vary depending on its cause. If the disorder is because of diabetes, treating this disease with medication and a proper diet should decrease the patient’s permanent thirst sensation.

If some medication causes potomania, the doctor could look for alternative drugs. And in the case of patients with mental disorders, the treatment of psychogenic polydipsia includes the following pillars: restriction of fluid intake, psychological therapy, drug therapy, and correction of hyponatremia (low sodium level), if any.

Correction of Hyponatremia

In most cases of psychogenic polydipsia, sodium remains at normal levels. But in 10% or 20% of cases, there may be mild, moderate, or severe hyponatremia. Symptoms of hyponatremia may go unnoticed unless the sodium concentration decreases rapidly.

Typically, hyponatremia in patients with potomania is mild or moderate and asymptomatic, especially if no other underlying disease affects blood sodium levels.

The severe and symptomatic hyponatremia that can occur in less than 48 hours without the intake of fluids is much higher than usual. The consequences of the decrease in sodium level in the blood can be harmful, causing cerebral edema, seizures, coma, and death.

That is why correcting the patient’s sodium levels is vital if they are low.

For correction, a hypertonic solution (3% sodium chloride) is the best option, which is applied intravenously. The correction should happen slowly because if the sodium level rises too quickly, negative consequences can also be.

Restriction of Liquids

As expected, the first thing to do when someone has potomania is to restrict their fluid intake. At the beginning of the restriction, the patient should consume between 0.8 and 1.5 liters of water every 24 hours. One way to know if a person drinks too much water during the day is by controlling body weight.

If you drink a lot of water, your weight will increase by up to 2.2%.

Psychological Therapy

The problem with fluid restriction is that many patients with potomania cannot comply. This is because they feel an uncontrollable desire to drink water.

In extreme cases, it may be necessary to confine the patient to an area that lacks water sources.

Through behavioral therapy, the therapist can apply some tools and techniques to change the patient’s behavior and thus reduce his anxiety if he does not drink water.

For example, the patient is given a 500 ml jug and told he can only fill it six times daily. When you feel like drinking, you can do it in small sips or try to distract yourself with other things so you do not drink more than you should.

In some cases, the reward system has been used with some success. For example, say the patient fulfills the objective of not drinking more than a liter of water that day. They are then rewarded tokens or points. And if it does not comply, it will be taken away.

As the therapy progresses, the therapist attempts to modify the patient’s thoughts, fears, and false beliefs about water intake.

The positive reinforcement of the appropriate behaviors and the tools the therapist offers to deal with anxiety usually give good results.

Throughout the treatment, the patient must keep a diary in which he notes what happened to him, how he felt, and how much water he drank.

After 12 weeks of treatment, the potomania should be under control.

Pharmacological Therapy

In cases of psychogenic polydipsia, the atypical antipsychotics, usually prescribed in patients with schizophrenia, bipolar disorder, major depression, and other mental illnesses, have proved to be quite effective for potomania.

• Clozapine In a 6-week study in which the evolution of 8 patients with schizophrenia who also had potomania was controlled, the results were good with this medication.
• Risperidone. It is another antipsychotic to relieve psychogenic polydipsia.

The patient may have potomania due to a mental disorder such as major depression.  In those cases, the urge to drink water can be spontaneously controlled. Treating the underlying disease will help control potomania. 

Confirmed Cases of Potomania

It is always interesting to know about real-life cases of these conditions that seem strange but may be more frequent than you think.

Case number 1: Potomania associated with major depression and panic attacks

In a hospital in India, a 25-year-old woman, divorced and of low socioeconomic status, was taking 12 to 25 liters of water daily (it is true, although you can not believe it!).

The lady also suffered panic attacks, anxiety, crying fits, headaches, and sleeping problems for about three years. He also had asthenia, poor concentration, and a depressed mood. In his clinical history, there was no history of psychiatric illness or anything flashy, except for an unhappy marriage that had ended some time ago.

In this case, despite the high water intake, sodium remained at normal levels. The doctors determined that the woman suffered from psychogenic polydipsia and major depression.

The symptoms of potomania disappeared after a brief period of fluid restriction and treatment with benzodiazepines, antidepressants, and psychotherapy.

Case number 2. Potomania caused by drugs

An 18-year-old boy went to the psychiatric service of a Spanish hospital due to his behavior disorders. The symptoms included episodes of aggression towards his parents. In his clinical history, there was no history of mental illness; however, in his life, the boy had always had problems with relationships and poor performance in school.

After some studies, doctors determined that he had a low IQ and suffered from intermittent explosive disorder and prescribed a medication called topiramate, used for treating epilepsy and migraines, among other conditions.

With this drug, the boy’s aggression symptoms subsided in four weeks, but he suddenly began to drink about 5 liters of water daily. The only possible explanation for this behavior change was a side effect of the medication. The doctors decided to remove topiramate, and the symptoms of potomania completely subsided in only four days.

Although we don’t know precisely how topiramate works, it is known to alter the functioning of sodium channels in neurons. This could cause elevated sodium levels in the blood and cause potomania in the patient.

Case number 3: Potomania with severe hyponatremia.

A 41-year-old man has had paranoid schizophrenia since he was 16. His treatment, which included haloperidol (an antipsychotic medication), was irregular. He went to the hospital’s emergency room with seizures one day.

The relatives said that he had drunk more than 5 liters of water for two years daily. Two or three days ago, he had been sleepy and nauseated. That day, they found him lying on the floor, convulsing and took him to the hospital.

In this case, the sodium level was deficient, only 119 mEq per liter, when the normal level is above 135 mEq per liter. Indeed this low sodium level was the cause of the seizures because other possible causes were ruled out.

They corrected his sodium levels with an intravenous hypertonic solution, and after two days, the symptoms of water intoxication had subsided entirely.

Also Read: Psychological Pregnancy: Symptoms and How to Detect It

As you can see, potomania can have different causes, but whatever it is, it is a condition that requires treatment.

If you know someone drinking more than four liters of water daily, or if this happens to you, you should immediately consult the doctor; you could be saving your life or the life of someone very dear.