Hallucinogen Persisting Perception Disorder (HPPD)

Hallucinogen persisting perception disorder (HPPD) is when you have repeated visual hallucinations and distortions long after using certain substances, like LSD and MDMA. For example, you may see colors more intensely or objects changing in size. These perceptions may last for seconds or carry on for months or years.

LSD (lysergic acid diethylamide), a hallucinogen, is often linked to HPPD. But this disorder can also develop after using other drugs.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) officially recognized HPPD as a condition in 1994, in the DSM-IV. Experts still have a lot to learn about HPPD, including effective ways to treat it.

Types of HPPD

HPPD has two subtypes:

• HPPD type 1: You have short-term hallucinations and changes in your perception, lasting seconds to minutes. They don’t get in the way of your daily life. Up to half of people who use hallucinogens report these “flashbacks.”
• HPPD type 2: You have hallucinations and perceptual changes that last for months or years. They cause significant distress and issues with daily functioning. About 1 in 25 people who use hallucinogens have HPPD type 2.

Symptoms of HPPD

Re-experiencing the effects of a hallucinogen long after it has worn off is the main symptom of HPPD. The perceptions may be the same ones you had when you used the substance. Or they may be different.

You may see:

• Shapes that aren’t actually there
• Moving figures in the corner of your eye
• More intense colors or light
• Halos or trails around objects
• Size distortions
• Visual snow or static

These may come on briefly as flashbacks. Or they may last for a long time.

HPPD causes

Researchers don’t know the exact cause of HPPD. But it likely involves changes to your brain after substance use, especially in the visual cortex.

Hallucinogens that have been linked to HPPD include:

• LSD, which is the most likely cause
• MDMA (methylenedioxymethamphetamine)
• Psilocybin
• Mescaline
• Psychostimulants

Hallucinogen use isn’t the only cause of HPPD, despite the name of the condition. Natural and synthetic forms of cannabis (marijuana) are the second most-reported substances tied to HPPD. Others include ketamine and alcohol.

Researchers haven’t identified any risk factors yet. But they’re studying if there’s a connection between this disorder and visual snow syndrome (VSS), migraine with aura and tinnitus.

Complications

HPPD, especially type 2, can cause severe distress and issues with daily functioning. It may be very hard to focus on anything but the hallucinations.

Other complications include:

• Depersonalization (feeling detached from yourself)
• Derealization (feeling detached from your surroundings)
• Anxiety
• Panic attacks
• Depression
• Suicidal thoughts and behaviors

In the U.S., you can reach out to the 988 Suicide & Crisis Lifeline if you’re thinking about hurting yourself. Call or text 988 anytime for 24/7 help from specially trained providers and counselors.

How doctors diagnose HPPD

Healthcare providers use criteria in the DSM-5-TR to diagnose hallucinogen persisting perception disorder. They’ll ask about your symptoms and substance use history.

It’s important to be honest about this history. This helps your provider tell the difference between HPPD and other conditions with similar symptoms, like schizophrenia spectrum disorders.

Your provider may recommend certain tests, like blood and imaging tests, to rule out conditions.

How is hallucinogen persisting perception disorder treated?

There’s no standard treatment for HPPD. That’s because there isn’t enough research on it. Certain medications may help reduce symptoms. Talk therapy can help you cope with symptoms and manage mental health complications, like anxiety.

The U.S. Food and Drug Administration (FDA) hasn’t approved any medications for HPPD. But your provider may prescribe one of the following medications to help with symptoms:

• Alpha-2 adrenergic drugs, like clonidine
• Antiseizure medications, like lamotrigine and levetiracetam
• Atypical antipsychotics, like risperidone and olanzapine
• Benzodiazepines, like clonazepam (for temporary use)
• SSRIs, like sertraline and fluoxetine

What can I expect if I have HPPD?

Due to a lack of research, it’s hard for healthcare providers to predict outcomes for people with HPPD. Each case is different.

It may take time to find a treatment plan that works well for you. Lean on your provider for support and guidance.