Psychiatrists warn against fasting without medical consultation

By Ahmet Taş | Wise News Press

ISTANBUL, TURKIYE — Dr. Günay Hajiyeva, a prominent psychiatrist at Üsküdar University NPİSTANBUL Hospital, has issued a critical warning for individuals with psychiatric disorders planning to fast during Ramadan, stating that such decisions must be made through individual clinical evaluations to prevent severe health relapses.

While Ramadan holds profound spiritual significance, Dr. Hajiyeva emphasizes that health must remain the priority, as prolonged hunger, dehydration, and disrupted sleep patterns can drastically alter the clinical course of mental illnesses. The sudden cessation of psychiatric medications to accommodate fasting hours is particularly dangerous, potentially leading to manic episodes, severe depression, psychotic symptoms, and a heightened risk of suicide.

The Impact of Biological Rhythm on Mental Stability

The human brain relies heavily on a stable biological rhythm, often referred to as the circadian clock. For many psychiatric patients, maintaining this stability is the cornerstone of their treatment. Dr. Hajiyeva explains that any significant shift in this rhythm can lead to biological instability.

"The brain loves routine; when the circadian rhythm is frequently altered, this biological instability is reflected in the clinical picture," Hajiyeva noted. For patients with bipolar disorder, the interruption of sleep for sahur (the pre-dawn meal) can trigger manic or depressive episodes. Those with a history of seasonal affective disorders are particularly vulnerable to these transitions.

Risk Analysis Across Different Psychiatric Conditions

The risks associated with fasting vary significantly depending on the specific psychiatric diagnosis. Dr. Hajiyeva detailed how various conditions might be affected:

• Major Depression: Prolonged fasting and the resulting blood sugar fluctuations can exacerbate low energy levels and deepen depressive moods. Adding physiological stress to an already low energy state often worsens the clinical outlook.

• Anxiety and Panic Disorders: Dehydration and hunger can trigger physical symptoms like palpitations and tremors. For an anxious mind, these bodily alarms are often misinterpreted as signs of "imminent danger," potentially increasing panic attacks.

• Psychotic Disorders: Consistency in medication is vital for managing psychosis. Altering medication times to fit fasting schedules can cause symptoms to resurface if the drug's therapeutic levels in the bloodstream are not maintained.

  
  

• Eating Disorders: The fasting process itself can negatively impact the control mechanisms of patients struggling with disordered eating behaviors.

Dangers of Unsupervised Medication Adjustment

One of the most critical aspects of fasting for psychiatric patients is the management of pharmacological treatments. Dr. Hajiyeva warns that adjusting medication without professional oversight can render treatments ineffective or even toxic.

Many psychiatric drugs are prescribed based on their pharmacokinetics—how long they stay in the system and how they reach steady-state levels. "Making changes without considering the half-life and effect duration of a drug can reduce treatment efficacy," Hajiyeva stated. For example, patients using Lithium face a high risk of toxicity if they become dehydrated, as lower water levels in the body can cause lithium concentrations in the blood to rise to dangerous levels. Similarly, some antipsychotics can cause a drop in blood pressure, an effect that is often intensified by long-term hunger.

The Myth of "Quitting When Feeling Better"

A common misconception in clinical practice is the idea that psychiatric medications can be stopped once a patient feels "stable" or specifically to allow for fasting. Dr. Hajiyeva clarified that these medications are not to be stopped abruptly. Instead, they require a gradual tapering process under strict medical supervision once a long period of stability has been achieved.

The consequences of sudden withdrawal can be devastating. "We often see patients in our clinical practice who suddenly stop their medication just to be able to fast, only to return a few weeks later in the midst of a severe crisis," Hajiyeva warned. This creates a significant burden not only for the patient but also for their families and the healthcare system.

When is Fasting Medically Discouraged?

According to Dr. Hajiyeva, there are certain "red flag" situations where fasting is considered medically high-risk for psychiatric patients:

1. If the illness is currently in an active phase.

2. If an episode has occurred within the last six months.

3. If medication dosages have been recently adjusted.

4. If there has been a hospital admission within the last year.

5. If there is a present risk of suicide or harm to others.

In these instances, the physiological stress of fasting significantly outweighs the perceived benefits, as it creates a high probability of disease exacerbation.

Conclusion: A Scientific Approach to Spiritual Practice

Ultimately, the decision to fast while managing a mental health condition is a medical one. Dr. Hajiyeva concluded that taking care of one's health is the most appropriate approach from both a medical and humanitarian perspective. Patients are urged to communicate openly with their psychiatrists before the start of Ramadan to develop a personalized plan that ensures their safety and maintains their hard-won mental stability.

www.wisenewspress.com