Hallucinogen Persisting Perception Disorder

The symptoms of hallucinogen persisting perception disorder (HPPD) can be quite diverse but mainly consist of persistent and recurring visual disturbances that mimic the effects of hallucinogenic substances. While the manifestation of these symptoms can vary significantly among individuals, certain characteristic disturbances are frequently reported.

Visual disturbances

The visual disturbances associated with HPPD can be intense and disorienting, leading to significant distress.¹ These disturbances often include:

• Tracers or trails. Trails appear to follow moving objects, giving the impression that they have been moving for a prolonged period of time.
• Halos or auras. Some individuals report seeing halos or auras surrounding people or objects, similar to the visual effects induced by hallucinogens.
• Geometric pseudo-hallucinations. These visual hallucinations² are often intricate, colorful, geometric patterns or shapes that overlay an individual’s field of vision.
• Intensified colors. Colors may appear more vibrant and saturated than usual.
• Flashes of color or light. Sudden and unexplained bursts of color or light may appear in a person's visual field.

Visual processing dysfunctions

In addition to the specific visual disturbances, HPPD may affect how an individual processes visual information. These effects can include:

• Difficulty focusing or blurred vision: Individuals may experience blurred vision or have difficulty focusing on objects.
• Alice in Wonderland Syndrome (AIWS): AIWS is a disorder characterized by perceiving objects as much larger (macropsia) or smaller (micropsia) than they actually are.
• Enhanced perception of floaters or visual snow: "Floaters," small moving spots in the visual field, or "visual snow," a static-like image disturbance, may be more noticeable and frequent.
• Afterimage persistence: The perception of an image may continue after an individual looks away from the object, persisting longer than is typical.

Aside from these visual symptoms, individuals with HPPD often report additional non-visual symptoms that can exacerbate the distress caused by the disorder.

Additional symptoms

• Disassociation: Individuals may experience feelings of derealization, which can result in a sense of detachment from their environment and/or themselves.
• Anxiety: Anxiety and panic attacks³ are common among individuals with HPPD, often stemming from the distress caused by persistent and uncontrolled visual disturbances.
• Depression: The occurrence of visual disturbances may impact daily functioning and lead to sadness, hopelessness, and depression.

Overall, the signs and symptoms of HPPD can significantly disrupt an individual's daily life, causing distress and sometimes leading to social isolation or withdrawal. Therefore, recognizing and addressing these symptoms may significantly improve the quality of life for those affected by this disorder.

The exact cause of hallucinogen persisting perception disorder is not well understood, but it is typically associated with the use of hallucinogenic substances. These substances can alter the brain's chemistry and structure, particularly in areas related to perception, cognition, and mood, potentially leading to the long-term symptoms of hallucinogen-induced persisting perception disorder.

Hallucinogens linked to HPPD may include:

• Lysergic acid diethylamide (LSD)
• Psilocybin (magic mushrooms)
• Mescaline (peyote)
• MDMA (ecstasy)
• DMT (ayahuasca)
• Cannabis, particularly high-potency strains
• Certain prescription medications, such as some antibiotics and antipsychotics

However, the onset or exacerbation of HPPD symptoms can also be triggered by various factors unrelated to hallucinogen use. These can include:

• Periods of intense stress or anxiety: High stress levels or anxiety can exacerbate symptoms of HPPD or trigger their onset in predisposed individuals.
• Certain medications: Some medications, particularly those that affect the brain's chemical balance, can induce or exacerbate HPPD symptoms.
• Substance use: The consumption of certain substances like alcohol or caffeine has been reported to worsen HPPD symptoms in some individuals.
• Certain lighting conditions: Strobe lights, glare from a computer screen, or other intense or changing light conditions can trigger or intensify visual disturbances.

Risk factors that might increase the likelihood of developing HPPD are still being explored. However, some identified potential risk factors include:

• Frequency and amount of hallucinogen use: Regular and heavy use of hallucinogenic substances appears to increase the risk of HPPD.
• Psychological susceptibility: Individuals with pre-existing mental health conditions, especially those related to anxiety and perception, may be more prone to HPPD.
• Individual drug sensitivity: Some individuals may be inherently more sensitive to the effects of hallucinogens, which may increase their risk of developing HPPD.

Not everyone who uses hallucinogens will develop HPPD, which suggests that other unknown factors may be at play. Furthermore, HPPD can sometimes appear after a single use of hallucinogens, indicating that individual sensitivity and reaction to these substances may play a significant role.

Treating hallucinogen persisting perception disorder primarily focuses on managing symptoms, reducing distress, and improving the individual's ability to function in daily life. There's still no known cure for hallucinogen persisting perception disorder (HPPD), so treatment strategies are typically customized to the individual's specific symptoms and needs.

Medication

Medication can be useful for HPPD treatment, particularly for managing associated anxiety and depressive symptoms. Medications that may be used include:

• Benzodiazepines: Certain medications may help manage anxiety symptoms, though they should be used cautiously due to the risk of dependency.
• Selective serotonin reuptake inhibitors (SSRIs): These antidepressants may help manage depression and anxiety symptoms.
• Antipsychotic medications: In some cases, antipsychotic drugs may be used, particularly if symptoms are severe.

Each individual's response to medication can vary, and what works best may depend on the individual's unique symptoms, overall health, and concurrent mental or physical health conditions. Do not start, stop, or change medications without discussing with your qualified medical provider.

Other treatment options

Alternative or complementary therapies may also offer some relief for individuals with HPPD. These could include:

• Mindfulness practices: Techniques such as meditation, yoga, or tai chi may help individuals manage stress and anxiety, potentially reducing HPPD symptoms.
• Acupuncture: Some individuals may find that acupuncture helps relieve their symptoms, though research on its effectiveness for HPPD is limited.

Self-care

An essential part of managing HPPD symptoms typically involves caring for one's overall health and well-being. These self-care strategies may include:

• Healthy lifestyle: Regular exercise, a balanced diet, and adequate sleep can contribute to overall well-being and help manage HPPD symptoms.
• Avoiding triggers: Substances such as caffeine, alcohol, or hallucinogens can exacerbate HPPD symptoms, so avoiding these may help manage the condition.
• Stress management: Techniques such as deep breathing, progressive muscle relaxation, and other strategies may help individuals cope with HPPD symptoms.

While the path to managing HPPD can be challenging, combining therapy, medication, alternative treatment options, and self-care may help individuals navigate their symptoms, reduce distress, and enhance their overall quality of life.

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 allows individuals to receive care from their own homes. HPPD patients may find this benefit particularly useful, as they may be more comfortable in familiar surroundings. With BetterHelp, you can be matched with a therapist who has experience treating HPPD. 

In addition to online therapy, numerous other resources are available to individuals with HPPD. The websites of government health agencies and national mental health organizations, such as the National Institute on Drug Abuse and the National Alliance on Mental Illness (NAMI), provide valuable information on hallucinogenic substances and mental health disorders, respectively.

Also, organizations such as the Multidisciplinary Association for Psychedelic Studies (MAPS) conduct and promote research on psychedelic substances, which may interest those seeking to learn more about the causes and potential treatments for HPPD. Support groups may also offer a sense of community for individuals with HPPD. While specific HPPD groups may be difficult to find, broader mental health or substance use forums may be helpful.

Emerging research adds to our understanding of HPPD, including its causes and potential treatments.

A key area of focus has been on the role of inhibitory-excitatory activity in low-level visual processing. One study proposed that HPPD symptoms may arise from an imbalance in this activity. Specifically, it suggests that GABA-releasing inhibitory interneurons may play a role in this misbalance. This finding offers a new perspective on approaching HPPD treatment, potentially targeting these interneurons to restore balance in the brain's visual processing system.

Adding to the expanding field of HPPD research, a 2022 case report introduced an innovative treatment approach with promising results. In this report, transcranial direct current stimulation (tDCS) was utilized to treat HPPD symptoms. tDCS is a form of non-invasive brain stimulation that uses a small electric current to modulate brain activity. Interestingly, this treatment resulted in a significant reduction, approximately 60%, in visual hallucinations and occipital delta activity.

While these findings are encouraging, they stem from a single case study. Therefore, larger-scale studies are essential to confirm the effectiveness of this approach and potentially incorporate it into future treatment strategies for HPPD. As research progresses, we hope to gain more clarity in understanding the physiological mechanisms of HPPD and the development of effective, standardized treatment protocols.

Here are some key statistics on HPPD:

• According to a study published by Frontiers in Neuroscience, around 4.2% of individuals who use hallucinogenic substances may develop HPPD symptoms.
• In the same study, approximately 33% of the participants who had a fully documented psychiatric history reported having a related to the onset of HPPD.
• An article by Frontiers in Psychiatry indicates that the visual symptoms of HPPD can persist for five years or longer in some individuals, underscoring the chronic nature of this disorder.
• On a positive note, a study published in 2019 found that therapeutic interventions, particularly , may effectively manage anxiety symptoms for those with HPPD.