Ramadan lifts the spirit, but for thousands of Moroccans, it also carries a warning

Every year, hundreds of millions of Muslims enter Ramadan and emerge from it reporting a lightness, a clarity, a sense of having reset, an experience science is now catching up to – and the data is striking.

A major systematic review published in early 2026, drawing on 20 studies conducted across 14 countries from Nigeria to Germany, found that Ramadan fasting reduced symptoms of depression in nearly three quarters of participants, eased anxiety in two thirds, and lowered stress in close to nine out of ten.

Overall psychological well-being improved in 71% of studies, and researchers point to a combination of factors that include increased spiritual engagement, stronger social bond, greater self-discipline, and measurable neurochemical shifts.

But inside that same body of research is a finding that deserves its own conversation, one that Moroccan scientists were among the first to raise, over two decades ago, in Casablanca.

The scale of the question

Bipolar disorder is more common in Morocco than most people realize, and more frequently missed. Studies conducted in Moroccan psychiatric hospitals suggest that fewer than one in five patients with the condition receives a correct diagnosis, and many are misidentified as having unipolar depression, sometimes for years. The correct diagnosis, research shows, takes on average a decade to arrive.

Applied to Morocco’s population of nearly 38 million, there would be at least 370,000 Moroccans living with bipolar disorder, the majority of them unaware of it, and most of them Muslim, and every Ramadan, they fast.

Bipolar disorder is, at its core, a condition of rhythm. The brain of someone living with it is unusually sensitive to disruptions in the daily patterns of sleep, meals, and activity, what psychiatrists call “social rhythms.”
And Ramadan is, by its nature, a month of beautiful disruption, with suhoor pulling sleep earlier and iftar shifting activity towards the evening.

The 2026 international review of 20 studies on Ramadan and mental health noted, “fasting alters social rhythm and sleep patterns, which are dynamic in many contexts of bipolar disorder” with evidence pointing to higher relapse rates, particularly manic episodes, regardless of medication adherence.

Casablanca, 1997

At Ibn Rushd University Psychiatric Centre, a team led by Dr. Nadia Kadri enrolled 20 stabilised bipolar patients during Ramadan 1997. All were on lithium, and all were clinically stable going in.

Forty-five percent relapsed, meaning had a manic or depressive episode severe enough to require hospitalization or psychiatric intervention. Seventy percent of those relapses hit in the second week of fasting alone, despite lithium levels having not not changed.

Even among patients who didn’t relapse, mood disturbances were measurable through the second and third weeks, with the most consistently recorded symptom across groups being insomnia.

The team framed Ramadan as an “experimental opportunity.” The month, they wrote, offers a natural, recurring test of what happens when social rhythms are abruptly reorganized.

Fourteen years later, a team at the same institution returned with 170 stabilized patients across two consecutive Ramadans , 111 fasters, 59 non-fasters. Published in World Psychiatry, the findings were unambiguous. The relapse rate among fasters was 33%. Among non-fasters, 15%. Fasting was associated with a nearly threefold increase in relapse risk.

Once again, lithium levels were similar across both groups. What differed was sleep: fasting patients lost roughly two hours per night compared to their baseline, a reduction that didn’t occur at the same rate in non-fasters.
One finding in particular complicates a common assumption. A significant wave of relapses in the 2014 study occurred not during Ramadan, but in the two weeks after it ended ,as the body readjusted.

The exemption exists for a reason

Islamic jurisprudence has long recognized that fasting is not obligatory for those whose health would be harmed by it. “Allah intends for you ease and does not intend for you hardship,” reads the Quranic verse most often cited in this context.

Scholars across the Maliki tradition, the dominant school in Morocco, hold that a person whose physician determines fasting poses genuine risk is not only permitted but advised not to fast.

The most consistent early warning sign across both Casablanca studies is insomnia, not the ordinary sleep shift Ramadan brings for everyone, but a marked inability to sleep during the hours that are available.
The second week of Ramadan is the most vulnerable window, the point at which 70% of relapses in the 1997 study clustered.

Other signals include unusual irritability, energy or talkativeness that feels out of proportion, or conversely a withdrawal and heaviness beyond ordinary fatigue.