Living with HPPD: Causes, Challenges, and Coping Mechanisms FHE Health

The same author reported two cases of cannabis-induced visual disturbances and correlated anxiety features. More recently, Clonazepam (6 mg/day) has been proved to be effective in improving cannabis-induced HPPD symptoms 50. On the other hand, the intrinsic abuse potential of benzodiazepines might be inconvenient in certain individuals with a past history of substance use 17,18.

Treatment

It’s unclear how many people experience this condition because people with a history of recreational drug use may not feel comfortable admitting this to their doctor. The common term “trip” refers to a drug-induced inner neurological experience in which sensory perception is altered while taking hallucinogenic drugs. Visual aberrations can occur periodically in healthy individuals – e.g., afterimages after staring at a light, noticing floaters inside the eye, blue field entoptic phenomenon or seeing specks of light in a darkened room. However, in people with HPPD, symptoms seem typically to be worse, but complication comes from the additional roles played by anxiety and fixation. Indeed, anxiety has been implicated in visual perceptual effects similar to HPPD,17 and authors have recognized the crucial role of attending to underlying anxiety and panic in recovering from the disorder. As part of the initial psychiatric assessment, extensive neuropsychological profiling was undertaken (Table 1).

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The various aspects of HPPD are largely self-reported by the patient that is presenting. The FHE Health team is committed to providing accurate information that adheres to the highest standards of writing. If one of our articles is marked with a ‘reviewed for accuracy and expertise’ badge, it indicates that one or more members of our team of doctors and clinicians have reviewed the article further to ensure accuracy. This is part of our ongoing commitment to ensure FHE Health is trusted as a leader in mental health and addiction care.

• If a history of psychedelic drug use is known, HPPD may be diagnosed correctly.
• Despite a significant improvement in her mood, the remission was only partially leading to a low-level continuous depression classified as dysthymia.
• While these symptoms are reported, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not include them on the recognized list of symptoms.
• The number of people with HPPD is low, and it’s more often diagnosed in those with a history of previous psychological issues or substance use.
• Lauterbach et al. reported the unique case of HPPD induced by the atypical antipsychotic Risperidone 60.

Health Conditions

Rather, a multifactorial origin of HPPD-related phenomena is to be assumed that may differ from case to case. The range of case-specific variables may extend from learning and kindling effects, individual reaction patterns to mental trauma and weak self esteem to other psychophysic vulnerabilities Hermle et al. 2008. Additionally, only a small spectrum of hallucinogens seem capable of eliciting flashbacks, with LSD being the leading causative agent. Closely amphetamine addiction treatment related to LSD in its psychotropic actions is psilocybin, which produces similar but shorter-lasting intoxications. The incidence of mental disorders in 200 Native Americans of the Navajo tribe after ritual use of mescaline was the subject of a recent study by Halpern Halpern, 2003.

HPPD Types

Flashbacks are common in people with posttraumatic stress disorder (PTSD). In PTSD, the flashbacks take over many of your senses at once and enhance your feeling of being in the past. To date, no studies have investigated the potential use of rTMS in HPPD. Interestingly, Kilpatrick and Ermentrout (2012) 86 studied the spatiotemporal dynamics of neuronal networks in HPPD, with spike frequency adaptation. This study reported that altering parameters controlling the strength of synaptic connections in the network can lead to spatially structured activity suggestive of symptoms of HPPD.

Implications for clinical practice

People typically take the drug in sugar cubes or on small gelatin sheets that dissolve on the tongue. Some people report episodes of HPPD (type 1) as pleasant, like a “free trip” where they get the good feelings of a hallucinogen without taking a drug. But more commonly, episodes of both types cause feelings of distress and anxiety. A dosage of 0.75 mg/die of Clonidine has been evaluated as a treatment option for nine HPPD patients 51,59 (Table 4). The total remission has been reported in a single patient with flashbacks and anxiety treated with 0.25 mg of Clonidine three times a day for two months 59. Lofexidine (0.2–0.8 mg/day) is a sympatholytic centrally acting α2 presynaptic adrenergic agonist that showed similar efficacy in some cases 23,65,66.

Living With Hallucinogen Persisting Perception Disorder

Other, non-visual symptoms can include recurrent synesthesias, dissociation, auras, depersonalization, and derealization3. Accompanying these hallucinations and sensory disturbances, the patient may report severe anxiety, which can escalate to full blown panic attacks1. There is usually a latent, asymptomatic period following the initial intoxication, before the onset of returning visual disturbances and other hallucinations. This latent period could range anywhere from minutes to years1118. The use of second-generation antipsychotics in HPPD patients without comorbid psychotic disorders is debated. At the same time, conflicting evidence exists on the antipsychotics effects in psychotic HPPD patients.

Differential Diagnosis

• Indeed, anxiety has been implicated in visual perceptual effects similar to HPPD,17 and authors have recognized the crucial role of attending to underlying anxiety and panic in recovering from the disorder.
• Among those who’ve taken hallucinogenic drugs, only 4% to 4.5% get HPPD.
• HPPD (Hallucinogen Persisting Perception Disorder) is an under-researched neuro-psychological condition involving distressing changes to visual perception following the use of drugs, including and especially psychedelic drugs.
• These include, but are certainly not limited to micropsia, macropsia, floaters, fractals, monochromatic vision, acquired dyslexia, visual snow, and other strange visual perceptions13.
• The more time that is spent finding out what works and what doesn’t, the easier it will be to create a sustainable life in recovery.

Benzodiazapines may also be used to eliminate HPPD I and significantly reduce the severeity of HPPD II11182122. These are generally considered to be the first line medications for treatment of HPPD. Although there’s no cure for the condition, treatment for HPPD can reduce hppd symptoms symptoms and help people with the disorder lead fuller lives.