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The combined effect of neurohormonal and RASS hyperactivity results in increased water and sodium retention, leading to volume overload (104), and cardiac and renal fibrosis, which is then aggravated with a functional decline (105)

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Psychiatry Res (2010) 181:13640.10.1016/j.pscychresns.2009.08.006 137 HulvershornLAKarneHGunnADHartwickSLWangYHummerTAet alNeural activation during facial emotion processing in unmedicated bipolar depression, euthymia, and mania