Every year, a few weeks before Ramadan, the same question starts coming up in psychiatry clinics across the region. Can I keep taking my medication and still fast? And underneath it, usually unspoken, a second one. If I have to choose, which matters more?
The good news is that for most people on antidepressants, fasting and treatment are not in conflict. What changes is the timing, and timing is something you can plan for. The trouble tends to come from people sorting it out alone, often by simply stopping their medication for a month, which is the one approach almost guaranteed to cause problems.
What fasting actually does to a medication schedule
During Ramadan, observant Muslims take no food or drink between dawn and sunset, and that includes oral medication. In practice it means the window for taking anything by mouth shrinks to the hours between iftar in the evening and suhoor before first light.
For a once-daily tablet, that's a minor adjustment. For anything more complicated, it needs some thought.
The fasting hours themselves are long here in summer, and the broken sleep that comes with late iftars and early suhoors is its own factor. Both of those matter for mood, which is part of why this is worth getting right rather than improvising.
Why stopping the medication is the worst option
The instinct to pause treatment for the month is understandable. It feels cleaner, and for some people it carries a quiet hope that they might not need to go back on it.
The problem is that antidepressants don't work like painkillers you can take a break from. Stopping suddenly does two things, and both are bad.
The first is relapse. The medication is doing a job, and a month off is more than enough time for the thing it was holding back to return, often worse than before.
The second is discontinuation syndrome, which is the body reacting to the drug leaving the system.
- Dizziness
- Electric-shock sensations in the head
- Nausea
- Irritability
- Flu-like symptoms
These symptoms tend to be at their worst with shorter-acting medications. None of this makes for a peaceful Ramadan, and it's entirely avoidable.
The straightforward case: once-daily medication
Most modern antidepressants are taken once a day, and most can simply be moved to iftar or suhoor without losing any effect. The choice between the two usually comes down to how the drug makes you feel.
If it tends to make you drowsy, taking it after iftar in the evening works well, and you sleep through the sedation. Mirtazapine and trazodone fall into this group, and they were probably already being taken at night anyway.
If the medication is more activating, or it disrupts your sleep, suhoor is the better slot so the effect lands during the day rather than at 2am.
Some medications are gentler on the stomach when taken with food, sertraline being a common example, in which case you take it with one of the meals rather than between them.
Fluoxetine is the easiest of all to manage, because it stays in the body for a long time. A shifted or even occasionally missed dose barely registers.
At the other end, paroxetine and immediate-release venlafaxine leave the system fast, which makes their timing more important and a missed dose more noticeable.
The cases that need more planning
Twice-daily medication is where it gets harder, because the two doses now have to fit into the evening-to-predawn window instead of being spread across the day.
Sometimes the answer is to take one at iftar and one at suhoor, with your prescriber confirming the gap is acceptable.
Sometimes it's better to switch to an extended-release version that only needs taking once, and that's a conversation to have well before Ramadan begins, not on day three.
Lithium deserves a separate mention. It isn't an antidepressant, but plenty of people on antidepressants are also on it, and it doesn't tolerate dehydration.
Long fasting days in the heat can push lithium levels up into a range that becomes toxic, so anyone on it needs proper advice and usually a blood test before deciding to fast at all.
When fasting is making things worse
For most people, a well-planned month goes fine. But fasting can also tip someone who was stable into trouble, and it helps to know what that looks like rather than pushing through and hoping.
- Mood dropping noticeably over the first week or two and staying down
- Sleep falling apart beyond the normal Ramadan disruption
- Discontinuation symptoms such as dizziness, nausea, or electric-shock sensations
- Anxiety or agitation climbing rather than settling
- Any return of thoughts that life isn't worth continuing
If a few of those show up together, that's a reason to speak to your prescriber, and possibly a reason to break the fast.
Islamic teaching itself exempts the unwell from fasting, and a relapse of a serious mental illness is illness. Many people still want to fast anyway, which is their decision to make, but it's worth making it with the full picture rather than guilt.
Have the conversation before Ramadan, not during it
The single most useful thing you can do is book a review with whoever prescribes your medication a few weeks ahead.
That gives time to shift timings, change a formulation if needed, check a lithium level, or work out a plan for the days you might not fast.
Sorting it out in advance is calm and routine. Sorting it out mid-month, in the middle of a discontinuation reaction, is neither.
If you're on psychiatric medication and unsure how to handle the coming Ramadan, Zivanza Wellness offers psychology and psychiatry consultations with clinicians who understand both the clinical side and what fasting means to the people doing it.
You can book an appointment in confidence.
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