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Guide to HPPD: How to Overcome or Reverse the Effects

Hallucinogenic persisting perception disorder, or HPPD, can develop as a result of long-term use and abuse of hallucinogenic drugs.

It is more than the experience of psychosis while under the influence of a hallucinogenic drug or a single flashback in the days following a “bad trip.”

HPPD is diagnosed only when the individual is no longer using hallucinogenic substances and continues to experience persistent flashbacks that can negatively impact their vision, cause anxiety, and make it difficult to function properly and manage day-to-day responsibilities.

It is a rare disorder.

Because it is so rare, it is often misdiagnosed and treated improperly as a result.

PSEUDO FLASHBACKS

The good news is that HPPD flashbacks are not as overwhelming as a regular flashback might be.

That is, rather than transporting the person back to that time and place mentally and emotionally in such a way that the person may not be able to separate what is real from what isn’t, HPPD creates visual disturbances only and not full-blown hallucinations.

DRUGS THAT CAUSE HPPD

PCP (phencyclidine), mushrooms, and LSD (lysergic acid diethylamide) are the drugs most commonly associated with the development of HPPD. These strong drugs have extreme ranges of potency and chemical makeup. They can be very dangerous for the brain and its long-term function.

However, it is not just chronic use of psychedelics like these that can contribute to the development of HPPD, also sometimes called “Alice in Wonderland Syndrome,” or AIWS. Heavy marijuana use can also trigger the disorder, as can use of other substances that cause alterations in perception.

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TYPES OF HPPD

There are two types of HPPD. People who have Type 1 experience short, occasional pseudo flashbacks. Those who have Type 2 experience continuous changes to their vision that come and go without warning.

SIGNS OF HPPD

The pseudo flashbacks in both cases can vary widely. Many people report experiencing any of the following as a part of HPPD:

  •  Colors may suddenly intensify or appear to be very bright.
  •  Color flashes may occur unexpectedly.
  •  Objects look smaller or larger than they actually are.
  •  Objects may seem to have halos around them.
  •  Images may appear within images.
  •  Reading may be more difficult, as words seem to jump and move on the page.
  •  Geometric patterns may appear and move though they are not really there.
  •  Outlines or traces of objects may appear and linger.
  •  Colors may not be as they seem; that is, blue may look purple or red may look green.

Most people who experience these can tell they are not real and that their eyes are “playing tricks” on them. However, they may still feel embarrassed or frustrated if it does not pass quickly.

HOW IS IT DIAGNOSED?

HPPD is usually diagnosed after all of the following causes of the flashbacks have been ruled out:

  •  Regular use and abuse of psychedelic drugs
  •  Current use of a psychedelic substance
  •  Underlying mental health disorders
  •  Reaction to medication
  •  Brain damage

Testing may be necessary to rule out these potential causes. If a history of psychedelic drug use is known, HPPD may be diagnosed correctly.

CAN THE EFFECTS BE REVERSED? 

Currently, no cure for HPPD has been found to be effective in the treatment of all individuals who are struggling with the disorder. Medications have been identified as effective in helping some people manage pseudo flashbacks caused by HPPD.

Some of the medications that have been found to be effective in treatment include:

Though there are cases that have reported a reduction or disappearance of symptoms after using the above drugs and others, there are often cases that support the use of one drug followed by another case study where the drug worsened symptoms.

For example, one older case found that risperidone use caused panic in one HPPD patient, while another study found that the use of risperidone taken with sertraline was effective for another patient after six months of treatment.

It is also important to note that several drugs were tried and found to be ineffective in the treatment of HPPD, including benzodiazepines.

A close up of an eye with a hazel colored iris

They served to exacerbate symptoms rather than relieve them.

WHAT IS THE TIMELINE FOR RECOVERY?

Because there is no single treatment protocol proven to be effective in the treatment of HPPD, it is important for people who are struggling with the disorder to be patient and try different methods under the direction of an experienced medical professional.

It is essential that those living with pseudo flashbacks stay committed to treatment. Suicide has been noted in patients who do not receive an accurate diagnosis and comprehensive treatment early in the process.

It is important to:

  •  Be aware of the symptoms.
  •  Immediately seek help.
  •  Continue with treatment until a positive solution is found.

Long-term recovery from HPPD means taking medications that can ease the experience of pseudo flashbacks and engaging in a lifestyle plan that supports mental health and wellness.

For this reason, treatment for HPPD often begins with care for a substance use disorder if the use of any mind-altering substance is frequent. In this case, HPPD may be identified as a disorder that co-occurs with addiction, requiring people to find a drug rehab program that allows them to take advantage of a combination of the following:

  • Medical detox support to manage withdrawal symptoms that arise emotionally, mentally, and physically
  • Therapeutic support that is traditional as well as experiential to allow for growth and healing on multiple levels
  • Peer support that is found in the creation of a therapeutic community
  • Family support and care to help everyone who is close to the person in crisis begin to heal together
  • Treatment for issues related to trauma and co-occurring mental health disorders like depression, anxiety, schizophrenia, and others
  • Long-term support in the aftercare process, as all co-occurring disorders, including HPPD, are managed and slowly brought under control

Though it can take time to find the right treatment regimen and begin to feel comfortable again, it is a process that is well worth the effort. 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.

It can take years for HPPD to begin. Even if drug use occurred a decade or more in the past, it might be that HPPD is the cause of the problem.

Sources

(Mar 2018) Visual hallucinations and lifetime use of hallucinogen perception persisting disorder associated recreational drugs: results from a large online survey. European Neuropsychopharmacology from https://www.sciencedirect.com/science/article/pii/S0924977X17321442

(2015) 25 years of Hallucinogen Persisting Perception Disorder- A diagnostic challenge. British Journal of Medical Practitioners from http://www.bjmp.org/content/25-years-hallucinogen-persisting-perception-disorder-diagnostic-challenge

(Oct 2012) Hallucinogen-persisting perception disorder. Therapeutic Advances in Psychopharmacology from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736944/

(2015) LSD-associated “Alice in Wonderland Syndrome” (AIWS): A Hallucinogen Persisting Perception Disorder (HPPD) Case Report. The Israel Journal of Psychiatry and Related Sciences from https://search.proquest.com/openview/19341bc934d85dd5d28bd14ad2ccb964/1?pq-origsite=gscholar&cbl=47717

(April 2011) Hallucinogen Persisting Perception Disorder (HPPD) After Marijuana Consumption: Clinical And In-vitro Evidence Of Cannabinoid (CB) Receptors In RPE Cells. Investigative Ophthalmology & Visual Science from https://iovs.arvojournals.org/article.aspx?articleid=2355085

A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD. Current Topics in Behavioral Neurosciences from https://www.ncbi.nlm.nih.gov/pubmed/27822679

(Mar 2018) What is hallucinogen-persisting perception disorder? Medical News Today from https://www.medicalnewstoday.com/articles/320181.php

(Mar 2018) Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives. Brain Sciences from https://www.mdpi.com/2076-3425/8/3/47

(April 2006) Naltrexone treatment of hallucinogen persisting perception disorder. American Journal of Psychiatry from https://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.154.3.437a

(2014) Flashbacks and HPPD: A Clinical-oriented Concise Review. The Israel Journal of Psychiatry and Related Sciences from https://search.proquest.com/openview/19341bc934d85dd50611a171e4b51c20/1?pq-origsite=gscholar&cbl=47717

(May 2006) Clonazepam in the treatment of psychiatric disorders: an update. International Clinical Psychopharmacology from https://journals.lww.com/intclinpsychopharm/Abstract/2006/05000/Clonazepam_in_the_treatment_of_psychiatric.1.aspx

(Jun 1996) LSD-like panic from risperidone in post-LSD visual disorder. Journal of Clinical Psychopharmacology from https://www.ncbi.nlm.nih.gov/pubmed/8784656

(Aug 2005) Hallucinogen persisting perception disorder after psilocybin consumption: a case study. European Psychiatry from https://www.sciencedirect.com/science/article/pii/S0924933805000933

(Jan 2015) Hallucinogen Persisting Perception Disorder and Risk of Suicide. Journal of Pharmacy Practice from https://journals.sagepub.com/doi/abs/10.1177/0897190014566314

(Feb 2016) Treatment Access Barriers and Disparities Among Individuals with Co-Occurring Mental Health and Substance Use Disorders: An Integrative Literature Review. Journal of Substance Abuse Treatment from https://www.sciencedirect.com/science/article/pii/S0740547215002627

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