With Ramadan underway, experts are advising clinicians that certain patients with mental health disorders may require close monitoring during the period.
Writing in the Lancet Psychiatry, an international team of experts call for clinician awareness of Ramadan fasting and active probing of Ramadan fasting practices among Muslim individuals.
The authors refer to previous studies which found relapses in depression and mania in previously stable patients with bipolar disorder during Ramadan, although other studies have shown an improvement in symptoms.
In studies, serum lithium levels remained stable during an intermittent fast from 10 to 12 hours; however, it is unclear how lithium levels might be affected during summer months in high-latitude countries, such as Canada and the UK, where the fast can last up to 17 hours.
The authors found no large studies evaluating the effect of Ramadan fasting for patients with eating disorders. Two small case series showed a potential worsening of disordered eating, suggesting that clinicians might need to closely monitor those at risk of disordered eating during the period.
Timing of medications should also be considered, the article states. In one study, more than 60 per cent of patients altered their medication regimen during Ramadan without seeking medical advice.