This assessment was made using the Wilcoxon test for the analysis of quantitative variables. A total of 40 male healthcare professionals were included in the study. Their mean age was There was no statistically significant difference between their leptin, NPY, and growth hormone levels measured after and before Ramadan.

In addition, no statistically significant correlation was found between their plasma ghrelin levels and phobic anxiety subscale, general severity index, and positive symptom distress index scores measured after Ramadan. However, no significant correlation was found between ghrelin levels and interpersonal sensitivity subscale scores after Ramadan.

While their scale scores measured before Ramadan were positively correlated with each other, there was also a positive correlation between their scale scores measured after Ramadan. Several studies examined the effects of Ramadan fasting on mental health [ 24 , 25 , 26 ].

Yousuf and colleagues examined the effect of Ramadan fasting on depression, anxiety and stress levels in diabetic patients, including fasting patients and 50 non-fasting patients. They applied the depression anxiety stress scale DASS before and after Ramadan, and reported a statistically significant improvement in depression, anxiety and stress levels in the fasting group after Ramadan [ 24 ].

One recently published meta-analysis has suggested that Ramadan fasting is associated with improvement in stress, anxiety, and depression [ 27 ]. Erdem evaluated the effects of Ramadan fasting on a sample of 73 healthy participants by applying DASS, and reported a statistically significant decrease in their depression, anxiety, and stress scores and frequency of anxiety after Ramadan compared to those measured before Ramadan [ 28 ].

Our results are partially compatible with those in the literature. Therefore, the SDIR was applied to participants in our study. However, there was no significant difference in their SDIR scores before and after Ramadan.

This result may be related to our study's small number of participants. A recent review study introduced various explanations for the differences in research results regarding the effects of fasting on mental health. Accordingly, while there was no significant change in depression, anxiety, and stress levels before and after Ramadan in individuals with initial normal mood, those with initial depression, anxiety, and stress had lower scale scores after Ramadan.

As a result, Ramadan fasting may have a positive effect on individuals with depression, anxiety, and stress [ 30 ]. Ramadan fasting can affect the circadian rhythms of various biological variables, including hormones [ 2 , 31 ]. Studies have shown a competitive interaction between ghrelin and leptin in the regulation of food intake [ 17 ].

Bogdan and colleagues reported a shift in the circadian rhythm of leptin on the 23rd day of Ramadan in males who fasted during Ramadan. Still, there was no significant change in their plasma leptin levels [ 32 ]. Alzoghaibi and colleagues found no significant change in ghrelin levels during and before Ramadan fasting, and determined a significant decrease in leptin levels at 10 pm during Ramadan [ 34 ].

Studies have shown that ghrelin increases not only in response to energy deficiency, but also after exposure to stress, and have reported that prolonged fasting increases plasma ghrelin levels [ 35 ].

It has been reported that ghrelin-induced anxiolytic and antidepressant-like responses in rats on a calorie-restricted diet or administered ghrelin. Therefore, activation of the ghrelin signaling pathway in response to chronic stress may be a homeostatic adaptation that helps individuals cope with stress [ 36 ].

Another study determined that ghrelin injection caused an increase in food intake, induced anxiety, and increased memory retention in rats [ 37 ]. The results of studies on ghrelin vary. This may be because of methodological differences model, type of subject, amount of ghrelin, research method, for example.

Although animal experiments shed light on potential mechanisms of ghrelin regulation of anxiety and depression, further studies are needed in humans. While there was a low degree of correlation between ghrelin levels and interpersonal sensitivity subscale scores before Ramadan, no significant correlation was found after Ramadan.

Therefore, no further evaluations can be made in this regard. Our study has some strengths. In some of the previous studies, a psychiatric examination was not performed, instead, a psychiatric assessment was based on symptom severity and relevant scales. In our study, all participants were interviewed applying SCIDCV according to DSM-5, so the diagnosis of psychiatric disease was ruled out.

To eliminate the possible confusing effect of BMI on the clinical results of leptin hormone produced from adipose tissue, only participants with a BMI between 19 and Blood samples were taken from all participants at am after 12 h of fasting, which was significant for the reliability of the clinical results of hormones that oscillated in a circadian pattern.

These details, considered in planning the study, are the strengths of our study. Our study also has some limitations.

Muslims are exposed to various life changes during Ramadan, such as mealtime, sleep—wake time, sleep duration, exposure to light, and exercise, which can affect their hormone levels [ 15 , 34 ].

Methodological differences sample selection, scales, methods used for biochemical analysis, evaluation times may have affected the study's results. The small number of participants is also a limitation of our study Additional file 1. Their plasma ghrelin levels increased after Ramadan fasting compared to those measured before Ramadan.

There is a need for better-structured studies with larger samples and more variables to elucidate these mechanisms that mediate the effect of Ramadan fasting on mental health.

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This study was supported by the Scientific Research Project Unit of The University Project No. The role of the funding body in the study was analysis of data. Department of Psychiatry, Faculty of Medicine, Malatya Turgut Ozal University, Malatya, Turkey.

Department of Psychiatry, Bursa City Hospital, University of Health Sciences, Bursa, Turkey. Department of Psychiatry, Faculty of Medicine, Inonu University, Malatya, Turkey.

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LGE, participated in conception, design, literature review, supervision and critical review of the study. MCT was involved in the material and data collection of the study. All authors read and approved the final manuscript.

Correspondence to Mustafa Akan. The study was approved by Inonu University Clinical Research Ethics Committee Date-Number: Stranahan, A. Impact of energy intake and expenditure on neuronal plasticity.

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Faul, F. Methods 39 2 , — Akoglu, H. Download references. Open Access funding enabled and organized by Projekt DEAL. Funding sources had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. Institute for Clinical Chemistry, Hannover Medical School, Hannover, Germany.

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Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily. Skip to main content Thank you for visiting nature. nature scientific reports articles article. Download PDF. Subjects Metabolism Psychology. Abstract Major depressive disorder MDD is frequently associated with poor response to treatment.

Introduction Major depressive disorder MDD is a severe mental disease predicted by the World Health Organization to be the leading cause of disease burden by 1. Results Metabolic serum parameters are comparable in the Ctrl and MDD group pre- and post-fasting Levels of glucose, insulin, triglycerides and ketones did not significantly differ in the Ctrl and MDD group at T1 Table 1.

Table 1 Comparison of metabolic parameters pre- and post-fasting in Ctrl and MDD. Full size table. Figure 1. Full size image. Table 2 Comparison of metabolic parameters in MDDlow in MDDhigh pre- and post-fasting.

Figure 2. Figure 3. Discussion Our study revealed similar effects of a 72 h fasting intervention on peripheral parameters of metabolism and stress systems.

Effect of fasting on metabolic parameters Fasting resulted in robust metabolic changes in both study groups that are in line with previous studies in mentally healthy individuals 12 , 31 , Effect of fasting on stress systems Fasting induces metabolic stress that in turn was shown to trigger an activation of stress systems HPA axis, RAAS, sympathetic activation 20 , 21 , 22 , which were reported to be dysregulated in the context of MDD 23 , 24 , 25 , 26 , Effect of fasting on depression scores In accordance to a previous study in healthy females 17 , fasting resulted in a significant increase in BDI-2 score in the Ctrl group, while no significant effect was observed in MDD patients.

Effect of fasting in MDD sub-groups based on symptom severity at the beginning of the fasting intervention Analysis of MDD sub-groups based on BDI-2 score revealed differential effects in the MDDlow and MDDhigh group in response to fasting. Conclusion This pilot study highlights a beneficial effect of fasting primarily in MDD patients that suffered from more severe symptoms and did not sufficiently respond to initial antidepressant drug treatment.

Limitations This study has several limitations. Subjects and methods Subjects The present study was approved by the local ethics committee at Hannover Medical School ethics application number in accordance to the principles expressed in the Declaration of Helsinki, and all participants gave their written informed consent before entering the study.

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