Hallucinogen Persisting Perception Disorder
Hallucinogen Persisting Perception Disorder, HPPD, is a long lived problem arising from past use of strong hallucinogenic drugs. The majority of patients with HPPD report a prior use of lysergic acid diethylamide (LSD). Life LSD dose does not appear to increase the risk to developing HPPD. That is, I have seen some patients who have tripped on acid multiple times and then developed HPPD, and others develop the same disorder after one or two trips. I liken tripping on acid to playing Russian roulette, but using chemicals instead of bullets. Developing HPPD without ever tripping on acid can also happen, but in my experience this is quite rare, and suggestive of another disorder in the nervous system that needs medical attention.
The usual HPPD patient knows better than his doctors what is going on. The patients I see in consultation often have seen an average of six other medical specialists before they found their way to my office. This is probably because HPPD is a rare disorder, and not something that neurologists, psychiatrists, psychologists, and ophthalmologists usually encounter in training. Ironically these are the specialists most often consulted by the HPPD patient. Too often the first (and mistaken) clinical impression is that the patient has a psychosis. This can set treatment on a wrong path.
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The majority of HPPD patients do not suffer from psychosis, or other signs of psychotic illness, such as auditory hallucinations and delusions. The disorder is for the most part a perceptual disorder in which visual information from the perceived world enters the brain but then cannot shut itself off. The result is lingering visual information, or a disinhibition of visual information processing, in the form of after-images, the trailing of images as they move through the visual field, flashes of light, and the formation of complex imagery on otherwise blank surfaces. Typical drawings from HPPD patients of what they see are shown on the right.
The first scientific description of the persisting visual phenomena described by LSD users may be found here.
Research in my laboratory later documented quite clearly that in the HPPD patient, when a visual signal from an image enters the brain, the signal stays around in consciousness longer than it does in the control subject who does not suffer HPPD. This finding has been found in three different studies of visual psychophysics. One finding, shown in Figure Five, was that LSD users see a flickering light as fused more often than non-users, because the eyes of the LSD user continues to see the light after it’s gone. For details click here.
A similar event occurred if a subject was exposed to bright light, and then tested for the ability to adapt to darkness. In this experiment, Dr. Ernst Wolf and I found that the dark adaptation of LSD users was reduced compared to non-drug controls because the LSD group could not mentally shut off the original light enough to see a tiny light when in the dark. See Figure 6.
This impairment could be important, for example, to persons needing night vision such as airplane pilots.
My colleague, Frank Duffy, and I also found characteristic abnormalities in the brain’s electrical activity in HPPD subjects, documenting that HPPD is a disorder which clearly takes place in the brain, and not simply in the imagination. Figures 7 and 8 below are examples of brain electrical activity maps (BEAMs) of an HPPD patient side by side with a group of normal individuals for comparison.
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I am researching HPPD for a psychology 101 project and was curious about what kind of hallucinogens trigger this disorder. Is there more reports of Hppd occurring in those who use lysergic acid diethylamide than those who use psilocybin, mescaline, MDMA, phenylcyclohexl piperidine, or marajuana?
I have had HPPD, Palinopsia, and Depersonalization for the past 23 years, since I was 17 years old, as the result of taking 1 hit of acid in my whole life during this time.
I underwent many tests to find and cure the problem, but it was not detectable and everything checked out normal. These symptoms cleared up 4 times over the past 20 years for a minute or 2 each time. Then everything returned back to distorted again.
At the time, 1994, no one heard of this so there was no information available about it. A few years ago an eye doctor I was suggested palinopsia, so I did more research and found out about HPPD, Palinopsia, and Depersonalization, and I have them all to a T! I also found a few articles in the J. Clin Psychiatry Journal that a few patients had the same symptoms and found cures using tegretol and Neurontin. I have tried these and they didn’t help me, except to relax.
I’m so happy to at least know that someone out there knows about what it is and can describe it so perfectly. I used to try to explain to doctors, and still do, what I was experiencing and no one understand it.
I also found an article on the Internet written by a Dr. Evans, from Texas I think, about Migraine Aura. This was the first to describe the symptoms of a millions dots, sensitivity to light, halos around objects, fluidity in static objects, visual snow, and grainy vision.
I then found out about Migraine-aura.org online and read a case about a man named Victor in an article by Klaus Podoll, which described exactly the same things that happened to me and what I’m experiencing.
So, now I’m writing to Mr. Abraham.
If anyone can help me or knows of any cure. Please contact me at jamesphilliard@yahoo.com
Best Regards everyone,
James P. Hilliard
@James
Dr James:
Thanks for your complex and personal post. I’m sorry to hear of your difficulties. The path of living with HPPD varies widely, but there is nothing that should stand in your way toward living a long and happy life with such a diagnosis. I say this having treated many patients over the last thirty plus years.
I am not sure about the role of persistent migraine aura in your case. The use of a hallucinogen preceding the onset of symptoms, in the absence of classical migraine headaches, points more to the former than the latter. But it makes sense that there are many bad things that can happen to the brain to lead to an HPPD-like visual disorder without a person ever taking hallucinogens. For example, temporal lobe seizures can look like HPPD at times. Clearly, a consultation to review your case history with a doctor in your area knowledgeable about HPPD may be helpful.
Sincerely,
Dr. A.
Hi, Jessica:
Although HPPD refers generically to the disordered associated with hallucinogenic drugs, it’s LSD, by far, which has had the strongest link to the disorder, compared to all the other drugs you’ve listed. I’ve seen cases of folks with HPPD from other stimulants, including psilocybin, mescaline, and even (rarely) patients on weed alone, or Ritalin. But LSD leads the pack as the most common cause of HPPD at this point in time.
Dr. A