EFFECT OF FASTING ON SERUM LITHIUM LEVEL AND MENTAL STATE IN

BIPOLAR AFFECTIVE DISORDER PATIENTS

ABSTRACT

Objectives: To compare the serum lithium levels in patients suffering from bipolar affective disorders before, during and after Ramadan and correlate the levels with their mental state.

Study Design: Analytical study

Place and duration of study: A tertiary care hospital of Peshawar between September to November 2006.

Subjects and Method: Patients meeting the ICD 10 criteria of bipolar affective disorder and taking lithium containing drugs were included in the study. They were assessed on three occasions i.e., Pre Ramadan, Ramadan and Post Ramadan using chemical as well as clinical parameters of serum Lithium, electrolytes and creatinine while for mental state parameters of Hamilton Depression Rating Scale and Young Mania Rating Scale were used.

Results: A total of 62 patients completed the pre Ramadan assessment while 57 and 56 attended the mid and post Ramadan assessment respectively. Their mean age was 31.4 ± 10.8 with majority (53) being males, married (44) with mean 8 years of education and mean illness was 8 years.

There was slight increase in serum lithium in mid Ramadan but this did not differ significantly with the results of before and after Ramadan, with individual values being 0.49 ± 0.21 mequiv/1 in pre Ramadan, 0.51±0.20 mequiv/1 in mid and 0.44± 0.23 mequiv/1 in post Ramadan period. There was no significant change in serum electrolytes at all three times.

Mood assessment was done using HDRS and YMRS and significant decrease in HDRS rating and YMRS scores were seen during and after Ramadan as compared to Pre Ramadan levels. No patient had a clinical relapse during the course of study.

Conclusions: Patients who have stable mental state and Lithium levels before Ramadan can be maintained on Lithium during Ramadan.