During the month-long observance of Ramadan, many Muslims across the world fast from sunrise to sundown. While there is a robust body of research on its effects on medical illnesses such as diabetes, Dr. Juveria Zaheer, a clinician scientist with the Centre for Addiction and Mental Health in Toronto, was surprised to discover there is little addressing the topic of mental health issues during Ramadan.
Working with her research trainee Dr. Zainab Furqan as well as other psychiatric professionals, Dr. Zaheer is the senior author of a report addressing what clinicians ought to consider for their Muslim patients with psychiatric disorders during the fasting period. She spoke with The Globe and Mail from the emergency department of CAMH.
Why did you feel it was important to address this topic?
Over 80 per cent of Muslims in North America fast and as a psychiatrist, even someone from the same background, I didn’t know how to adjust someone’s medications. I didn’t know what questions to ask.
So Dr. Furqan and I conducted a literature review around mental health issues during Ramadan. We know that this is an area where we need to do more research and advocacy but in the interim, we compiled this information to support clinicians, whether they have a Muslim background or they don’t, working with Muslim people who may be fasting during Ramadan.
The report notes that the pre-dawn meal can interrupt circadian rhythms and sleep cycles. How does this affect treatment?
There are certain psychiatric illnesses wherein people are very sensitive to sleep disruption. Chief among them is bipolar disorder, where evidence suggests decreased sleep or interruptions can put people at risk of relapse or worsening symptoms. There are a few studies about fasting during Ramadan for people with bipolar disorder and the evidence is mixed but clinicians need to be aware of this issue. And if they know their client is particularly sensitive to sleep disturbance, fasting may not be the best idea in that moment.
But also balancing that with the fact that Ramadan fasting is cherished by Muslims across Canada and across the world. It has a lot of protective factors in terms of community, support and meaning and so we want to be careful to suggest people with mental health issues shouldn’t fast or they should fast. Rather, we want to balance the risks and benefits.
You refer to a study that says 60 per cent of fasting patients altered their dosage without seeking medical advice. How do you see that affect people who are dealing with mental disorders or issues?
I take for granted that because of my own background I know that fasting means abstaining from oral medications. But I think there are a lot of mental health providers out there who may not think or be aware of that. It’s important to realize that if someone’s fasting they might not be able to take their medications at the usual time. Opening up that dialogue and trying to figure out a plan around medication could be helpful.
There’s also some medications that can be really sensitive to changes in eating and drinking so just to be aware of these issues is important.
In your analysis you mention several Imams suggest patients can receive a long-acting injectable while fasting. What role can an Imam play in addressing difficulties in fasting and medication?
One of the really great things about mental psychiatry is that we are able to reach out to experts in Muslim mental health across the world. We want to create a culture where even within our Muslim communities we address stigma and Imams are gatekeepers, they are the leaders of our communities. If they are able to have a positive and accepting attitude toward mental illness, that goes a long way in the community.
What do you hope to achieve through this paper?
I hope this paper can be the basis of conversation for spiritual providers, for families, and for mental health providers to consider the holistic piece and to know that fasting is important, religion is important and mental health is important and consider how we can integrate all of these in the most positive way for our patients.
This interview has been condensed and edited.
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