HPPD: Symptoms, causes, and treatment

Hallucinogen Persisting Perception Disorder (HPPD) is a neurological condition that develops following the use of hallucinogenic substances such as LSD, psilocybin (commonly known as magic mushrooms), or MDMA (ecstasy). What sets HPPD apart is the re-experiencing of visual disturbances—often referred to as “flashbacks”—even when the individual is no longer under the influence of the drug. These disturbances may include halos around objects, trailing images, or intricate geometric patterns. Unlike typical flashbacks, which are brief and sporadic, HPPD symptoms can persist for weeks, months, or even years. Hallucinogenic persisting perception disorder is characterized by the recurrence of visual phenomena caused by psychedelic drugs for days, months, or even years after the trip. In mild forms of the disorder (HPPD Type I), these visual disturbances are transient, while in more severe cases (Type II), they’re pervasive and seemingly irreversible and cause impairment and distress.

The number of people who experience flashbacks shortly following the use of hallucinogens can range from 5% to 50%, but research estimates that between 1% and 3% of people will develop HPPD. Hallucinogen Persisting Perception Disorder, as defined by the DSM-5, is specifically caused by hallucinogenic drugs, primarily but not exclusively by LSD (lysergic acid diethylamide). The disorder occurs in about 4.2 percent of people who take hallucinogens. The crucial movement towards a comprehensive clinical understanding of Hallucinogen Persisting Perception Spectrum Disorders (HPPSD) 23 is the establishment of an accepted operative nomenclature. This wide spectrum of disorders encompasses different subtypes, ranging from HPPD I to HPPD II, according to our hypothetical distinction. Among the innumerable triggers able to precipitate HPPD, prospectively, the use of natural and synthetic cannabinoids appears to be the most frequent.

• A general misunderstanding or lack of awareness of HPPD II among doctors may lead to misdiagnosis or ineffective treatment.
• Some refer to it as a form of micropsia or macropsia, meaning they see things smaller or larger than their actual size.
• Questionaries and scales exist to help determine the presence and severity of HPPD.
• Telemedicine offers a convenient way to consult healthcare providers from the comfort of your home.

Other Literature Sources

• All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.
• Some reports state flashbacks occur due to how a person’s nervous system reacts to using hallucinogens.
• When the person with HPPD experiences a flashback, loved ones can help them feel safe and remind them that symptoms are temporary.
• It is also important to note that several drugs were tried and found to be ineffective in the treatment of hallucinogen persisting perception disorder, including benzodiazepines.
• Visual acuity (VA) was examined in 11 patients, and automated perimetric visual field assessment was available in 10.

The risk of developing HPPD doesn’t correlate with frequency of use – alcoholism symptoms some users experience symptoms after a single exposure, while others develop issues after multiple uses. Although many people will see a reduction in symptoms over time, HPDD is still likely to be long-lasting and persist for many years. Researchers are looking into whether brain stimulation may work as a way to relieve HPPD symptoms, but studies are still ongoing. This drug is approved for use as an injectable, short-acting anesthetic and a nasal spray for depression.

Visual processing dysfunctions

Bipolar disorder is characterized by extreme mood swings, including manic episodes (elevated mood, increased energy) and depressive episodes (low mood, fatigue). Hallucinations or delusions may occur during severe manic or depressive episodes. Examination and investigation were normal in the majority of patients. Visual acuity (VA) was examined in 11 patients, and automated perimetric visual field assessment was available in 10.

These symptoms persisted for the last 13 years, with little change in intensity and frequency. All efforts at treatment, psychopharmacological as well as psychotherapeutic, failed to alleviate the symptoms. Often the patient was unable to focus properly with her eyes and tired rapidly while performing intense visual tasks – these deficiencies being detrimental to her studies and professional work as an architect. As a consequence, the patient became depressed with latent suicidal impulses.

Substances

The more sufferers ‘monitor’ and fixate on their symptoms and their implications – how their lives are now ‘ruined’, how they ‘did this to themselves’ – the more apparent and disturbing the symptoms will appear. In this respect, early psychotherapeutic evidence suggests that strategies found in Cognitive Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT) may be considerably helpful. If you or someone you know is dealing with symptoms of HPPD, you’re not alone—and help is available.

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. The common term “trip” refers to a drug-induced inner neurological experience in which sensory perception is altered while taking hallucinogenic drugs. Hallucinogen persisting perception disorder (HPPD) is characterized by a reoccurrence of a hallucinogen drugs’ effects days, weeks, or years after the drug was last used. Abraham set about quantifying these symptoms, and his research has since led to the recognition of HPPD in psychiatry, pioneering the movement towards trying to find a cure.

• Such was the course of action in our patient’s management described above.
• Certain lifestyle choices can increase the likelihood of developing HPPD.
• Abraham suggested that all three can arise from a broader mechanism of disinhibition in sensory perception, affect and sense-of-self occasioned by psychedelic experience.

Therapy can be an important part of hallucinogen persisting perception disorder (HPPD) management, and online therapy offers a flexible and comfortable way to receive treatment. Online therapy connects individuals with licensed therapists who can provide evidence-based treatment, such as cognitive-behavioral therapy (CBT), tailored to their unique needs and symptoms. This type of treatment what is alcoholism allows individuals to receive care from their own homes.

If symptoms are primarily visual and linked to past drug use, HPPD is the more probable diagnosis. Treatment for anxiety disorders often involves therapy or medication, while HPPD requires a different treatment approach. Healthcare providers may perform psychiatric evaluations to distinguish between the two conditions. Schizophrenia symptoms are generally more complex, affecting multiple senses and cognitive functions, while HPPD primarily involves visual disturbances. Schizophrenia often develops gradually over time, whereas HPPD symptoms appear after drug use.

Dr. Locke stays up-to-date with the most current clinical guidelines and offers a tailored approach to care based on each patient’s unique situation. Hallucinogen Persisting Perception Disorder (HPPD) is a lesser-known but serious condition that can have a significant impact on those who experience it. If you are dealing with HPPD, you are not alone—this disorder is recognized in the DSM-V, yet it remains underdiagnosed, with fewer than 1% of psychologists familiar with its symptoms and treatment. As a Harvard-trained psychiatrist with decades of experience, Dr. Steven Locke is at the forefront of addressing HPPD and helping individuals manage and treat this condition. 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.