In this article, we’ll make recommendations regarding several important things that mental health clinicians need to do and discuss with any Muslim patients who plan to fast during the Muslim holy month of Ramadan (also called Ramzan).
Before we go over those recommendations, let’s briefly go over the minimum key facts about Ramadan for those who may not be familiar with them.
Basic Facts about Ramadan
– Muslims believe that Ramadan celebrates the revelation of the Holy Qur’an by God to the Prophet Muhammad.
– Using the Gregorian calendar that is used in Western Countries, Ramadan occurs on different dates each year because Muslim holidays, including Ramadan, occur based on a lunar calendar.
– Since Ramadan occurs based on the lunar calendar, it can occur during any season of the year. When Ramadan occurs during the summer, the duration of the fast is longer because the days are longer.
– The main reason why Ramadan is important from the viewpoint of psychiatric medications is that during the entire month of Ramadan, Muslims are supposed to fast from sunrise to sunset. Importantly, no water or other fluids are supposed to be consumed. Smoking and sex are also prohibited during those hours (Abolaban and Al-Moujahed, 2017).
– Those who are fasting typically wake up before sunrise to eat a light meal called Suhoor, which must be completed before dawn. Many of them go back to sleep after this meal (Furqan et al., 2019).
– And, after sunset, they enjoy a lavish feast called Iftar that includes a variety of special foods and sweets that are only served during Ramadan.
– Immediately after Ramadan ends, an important Muslim holiday—Eid al-Fitr—is celebrated.
– Traditional ways to greet a Muslim person during Ramadan are to say one of the following:
- “Ramadan Mubarak!” (ruh-mah-dahn muh-bah-rak), which means, “May your Ramadan be blessed.”
- “Ramadan Kareem!” (ruh-mah-dahn kuh-reem), which means “May your Ramadan be generous.”
Why is Ramadan fasting relevant to psychiatric medications?
– It is important for clinicians treating Muslim patients to know that those who are fasting during the month of Ramadan are not supposed to take any oral medications while they are fasting between sunrise and sunset.
– Some patients may stop taking their medications or change how they take the medications on their own and without consulting with the treating clinicians (Abolaban and Al-Moujahed, 2017).
– Important! Patients with bipolar disorders or schizophrenia may become destabilized during the month of Ramadan due to multiple factors, including changes in circadian patterns, sleep deprivation, and increased consumption of coffee (Eddahby et al., 2014).
Discuss Ramadan fasting and exemption well in advance
– Patients, clinicians, and family members should share responsibility for anticipating the issue of fasting during the month of Ramadan and discussing it several weeks in advance. This will leave enough time to comfortably make changes in medications or how they are taken.
– Important! Many of our patients may be excused from Ramadan fasting based on their medical condition. Patients, clinicians, and family members should know about the conditions that exempt Muslim patients from the religious requirement to fast during the month of Ramadan. These include the following (Bhuiyan et al., 2024; Abolaban and Al-Moujahed, 2017):
1. Based on age
-
- Prepubertal children
- The elderly, if they cannot tolerate the fast
2. Women
-
- If having their menstrual period
- If bleeding after having delivered a baby
- If pregnant or breastfeeding and believe that the long fasts may harm them or their baby
3. Travelers
4. Mentally disabled
5. Medically ill persons, if fasting will worsen their medical condition
– Despite these religious exemptions, many patients who are exempt from fasting due to their medical condition still choose to fast during the month of Ramadan because of its deep religious significance to them (Furqan et al., 2019).
Psychiatric medications during Ramadan fasting
1. Psychiatric medications that are NOT prohibited during Ramadan fasting
Certain religious authorities issue rulings about which actions do or do not invalidate Ramadan fasting. Relevant to mental health treatments, the following treatments are NOT prohibited (Furqan et al., 2019; Abolaban and Al-Moujahed, 2017):
1. Injections like long-acting injectable (LAI) antipsychotics, naltrexone extended-release injectable, and so on.
2. Nicotine patches being used for tobacco smoking cessation.
2. Oral medications will need to be taken before sunrise or after sunset
– Patients should plan to take their psychiatric medications with water or other fluids either before sunrise or after sunset. This includes medications that MUST be taken with food—lurasidone, vilazodone, and ziprasidone (see our article Which psychiatric medications MUST be taken with food?).
– Only for some psychiatric medications, it may be better to transition the patient to a longer-acting preparation of the same medication before Ramadan starts, for example, from alprazolam immediate-release to alprazolam extended-release.
3. Lithium
– When Ramadan occurs during the summer, the duration of the fast is longer because the days are longer. Also, the hot weather, combined with the prohibition of water or other fluids, means that there is a risk of lithium toxicity. Note: In one study that did not find serum lithium levels to change significantly during Ramadan fasting, the average lithium level was only 0.45 (Farooq et al., 2010). Also, the study was conducted in a year when Ramadan occurred in the fall and not in the summer.
– Due to this risk, along with potential destabilization due to circadian rhythm changes, sleep deprivations, and so on, patients with bipolar disorders who are taking lithium should seriously consider not fasting during the month of Ramadan based on exemption due to their illness.
-Taking the entire dose of lithium in a single dose at night, which is recommended for all patients anyway, is particularly important during Ramadan fasting.
– Patients on lithium who keep the fast during Ramadan should be monitored frequently during that month—clinically and by checking the serum lithium level as often as is needed.
– These patients should be specifically advised to drink plenty of fluids between sunset and sunrise.
Related Pages
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References
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