What special considerations should clinicians keep in mind when treating Muslim patients with mental illness who fast during Ramadan?

Although there are almost two billion Muslims worldwide, this question has rarely been explored in scientific literature.

Until now.

“We found a lot of data about implications for physical health during Ramadan, but very little on mental health,” said Senior Author Dr. Juveria Zaheer, CAMH Clinician Scientist with the Institute for Mental Health Policy Research and senior author of “Considerations for clinicians treating Muslim patients with psychiatric disorders during Ramadan, published in Lancet Psychiatry. “We felt there was a real gap in information for clinicians treating patients with mental illness while fasting.”

Ramadan is a spiritually significant period for Muslims worldwide that includes fasting without food or water from dawn to dusk for approximately one month.  While exceptions are made for infirmity, age, pregnancy and other factors, fasting is considered obligatory for those who are able.

Depending on the time of year Ramadan occurs, the daily fast can last for up to 17 hours, especially in higher latitude countries like Canada. The authors state that this can have a significant impact on sleep cycles, a reduction in REM sleep and disruption of the body’s circadian rhythms, which has been linked to the onset or a relapse in certain psychiatric disorders.

Another significant implication for mental health treatment during Ramadan fasting is the timing and dosage of daily medications.  The authors note that in one study, over 60 per cent of patients altered their medication schedule during Ramadan without seeking any medical advice.

Some clinical considerations for people receiving mental health treatment recommended by the authors include:

  • Increased monitoring of symptoms in patients with bi-polar disorder who may be sensitive to circadian rhythm disturbances.
  • Discussing the risk of fasting for patients with a history of eating disorders.
  • Including the patient’s spiritual supports in decision making.

“It is important for clinicians not to undermine the significance of this spiritual practice,” said first author Dr. Zainab Furqan, resident physician at CAMH. “A better understanding of the impact of fasting on health can allow for more nuanced decisions between clinicians and patients, so that informed decisions can be made about balancing faith-based practices and health.”

For further information, or to arrange an interview, please contact Sean O’Malley, Media Relations, CAMH, 416-595-6015 or media@camh.ca

ABOUT THE CENTRE FOR ADDICTION AND MENTAL HEALTH

The Centre for Addiction and Mental Health (CAMH) is Canada’s largest mental health and addiction teaching hospital and a world leading research centre in this field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental illness and addiction. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please follow

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