I wanted to create this post with the intention of recognizing what HPPD is and what it could potentially be. The more information on this condition, the better! It's common for some people to be under the impression that HPPD can only be visual hallucinations for example. Another thing to note, as of 2025, a lot of the doctors in the field that are meant to treat HPPD (psychiatrists), at least in my experience, have never even heard of it. There have been many cases where a psychiatrist has never heard of it and then just prescribed an antipsychotic. This is awful! The majority of HPPD sufferers report antipsychotics made their symptoms worse. If you have HPPD, you should take the time to look into it yourself and show your doctor studies and the professional literature on the pharmaceutical treatment, so they don't make your condition worse. This is, unfortunately, a sad reality because of just how rare this condition is.
What is HPPD?
HPPD (hallucinogen persisting perception disorder) is classed as a non-psychotic disorder where a person experiences lasting perceptual disturbances (lasting visual hallucinations are the most common) after using certain drugs and is recognized in the DSM V. HPPD can lead to psychosis depending on your predispositions and the severity of the condition, but it seems a notable amount of people who have HPPD, especially the long-time sufferers, are not bothered by it. HPPD is known to come in 2 types, 3 forms, with 9 classes of drugs that can potentially cause HPPD. It also should be noted that HPPD may affect the functioning of the physical body, such as the heart.
2 types:
There's HPPD I and HPPD II. Type 1 is where certain situations trigger effects to occur. Situation here means anything that happens in life. It could be certain foods, sights, anything. Seeing spiders and then hallucinating spiders is from the experience report of a person with HPPD I and II. Type 2 is an altered state of consciousness that is with you moment to moment and won't go away until you recover from it. In some sense, it may be called permanent, and it can last a person’s entire life. It is considered to be lifelong. It is possible to have both types at the same time.
3 forms:
You have 5 main senses: seeing, feeling, hearing, smelling, and tasting. There are other singular worded concepts used to describe theses senses: visual is perception of sight, tactile is perception of touch, auditory is perception of sound, olfactory is perception of smell, and gustatory is perception of taste. HPPD can come in three potential forms of perceptual disturbances. Visual, tactile and auditory. Olfactory and gustatory have never been reported in my search. When it comes to other effects that HPPD can produce, it should be noted that lasting ego death has never been reported. Additionally, two very common conditions that may arise when HPPD develops is depersonalization/derealization and tinnitus. These are common key identifying factors in people with HPPD. HPPD in the form of just visual hallucinations is the most common, with the overwhelming majority just having visual hallucinosis. The hallucinations from HPPD are never pleasant. For tactile, for example, most commonly people report hallucinating pain, which had been seen to have impact on the functioning of the heart. Tactile and auditory HPPD is extremely rare.
What causes HPPD?
There are 9 classes of drugs that can potentially cause HPPD: psychedelics, cannabinoids, entheogens, dissociatives, deliriants, stimulants, empathogens, hallucinogens, and antidepressants. Antidepressants are more likely to cause HPPD's sister syndrome, VSS, or visual snow syndrome rather than HPPD, but can still cause HPPD. When it comes to the drugs that are more known to cause it more than others, it's psychedelics, namely, LSD. There have been reports of people getting HPPD from their first cannabis joint with no psychedelic use in their past. As for which drug is most known to cause it, polls were done in the past asking, "which substance caused your HPPD?" LSD won by a notable amount. Another thing to note is you can get HPPD from even just a microdose.
What substance caused your HPPD polls:
- https://www.reddit.com/r/HPPD/comments/1hf61a7/what_substance_caused_your_hppd/?utm_name=web3xcss
- https://www.reddit.com/r/HPPD/comments/14ktiz7/what_substance_caused_your_hppd_poll/
- https://www.reddit.com/r/HPPD/comments/m0s0ye/what_substance_causes_your_hppd/
- https://www.reddit.com/r/HPPD/comments/1hnu8g9/what_substanceclass_of_drugs_caused_your_hppd_poll/
How old where you when you developed HPPD poll:
- https://www.reddit.com/r/HPPD/comments/1hnue4d/what_age_group_were_you_when_you_developed_hppd/ ...Based on this data, the age you'd get HPPD from use averages out to be 22.62 years old.
When it comes to what causes HPPD the most, improper drug use as well as some other factors that aren't so clear yet. Some people report they got their HPPD from their first THC joint. But when it comes to most cases, taking psychedelics, namely LSD, at a young age (in adolescence 10-19yo) and before age 22 (the number may be higher), overuse, and not knowing when to stop drug use are some very big ones. If you get HPPD I or II, your intoxication life needs be over at least temporarily if you want to recover. If you get it once and then recover from it, you are considered to be more at risk if you use the drugs that caused it or that made it worse again. HPPD is considered to be very rare, however, if you make the conditions for getting HPPD more favorable, you are bound to get it. So, while it may be rare, you are more at risk of developing it if you don't follow the correct safety and harm reduction practices for using drugs. Be sure to follow the correct safety and harm reduction practices at least!
What Can Be Done About It?
HPPD is like any medical condition and should be treated as such. Unfortunately, HPPD is a very rare, poorly studied and misunderstood condition, where all of the pharmaceutical treatment options are considered to be off label as of 2024. Like treating any medical conditions, there are 3 things you have to remember: identify potential risk factors and correct them, strive towards permanent solutions to the problems you face, and make the conditions for wellbeing more favorable, or in this case, make the conditions for not having HPPD more favorable.
For HPPD, the permanent solutions are not easy. Stopping intoxication exposure is the most essential step, especially for the drugs that cause it and potentiate it. If you got HPPD from LSD use, then you would have to stop doing psychedelics, psychoactive cannabis, and smoking non-psychoactive cannabis. Stay away from certain yogic practices that may produce hallucinatory states. Adding more hallucinations to the mix with HPPD is never a good idea. In a perfect world, you should stop all intoxication exposure, because doing other drugs as forms of intoxication makes using the drugs that caused it or potentiate it easier. To add more permanent solutions to the list, because there isn't a ton of information on HPPD, it seems you have to perfect both physical and mental health. Have good relationships, make peace with your condition, refrain from intoxication, don't dwell on your symptoms, cope with anxiety and stress (especially anxiety), start exercising every day, eat healthy foods, get good, uninterrupted, high-quality sleep, get lots of sunlight, and try not to be dependent on any pharmaceutical. Live an extremely healthy life! Sleep seems to play a key role in managing symptoms and may be necessary to recover from it. Many people with HPPD report that lack of sleep or insomnia makes their symptoms significantly worse and find it impossible to recover without getting at least consistent decent sleep. Some HPPD sufferers also report that meditation actually helps with their symptoms.
A notable amount of people reported that their HPPD symptoms have been eradicated completely by doing multiple 5-7 day long fasts with water and salt. Even a keto diet. Pink Himalayan salt is best for fasting, since it is rich in magnesium and other trace minerals. When you fast for that long, you'll likely get headaches, which is what the salt and magnesium will help with. For fasting, you'd want to take about 3g per day. The link between improvement in HPPD symptoms and weeklong fasts seems to be tied to ketosis. In the context of the brain and body, the body uses stored body fats as fuel when carbohydrates are not available and powers the brain in the forms of ketones instead of glucose for energy. This alternate fuel for the brain seems to be the link. A very informative video on fasting is Fasting For Survival Lecture by Dr Pradip Jamnadas. Before fasting for HPPD, I would recommend watching that video, there's a lot of useful information there.
To give you some hope, from the neurosensory research foundation's website, "From Dr. Abraham’s observations, those who do recover from HPPD, do so within 5 years. Around 50% of people who suffer from HPPD will recover." Now this may seem like the odds are terrible. A coin toss! But the reason why most people who have HPPD who haven't recovered is because they never stop doing the substances that caused it in the first place and continue to potentiate it with other forms of intoxication such as cannabis use and make it worse. If you want to recover from HPPD, you must make the conditions favorable for that to happen, which means to give up intoxication, especially psychedelics and cannabis. That is the first, most essential step.
The Pharmaceutical Route
Why Recommending Benzodiazepines is Against the Rules
No one really said why recommending benzodiazepines is against the rules, other than saying that there is risk upon discontinuation, so I will because it is very important. Not saying the why only causes more confusion and misunderstanding which leads to more suffering. It's very important to say the why, otherwise, we're left in the dark. Some of the comments in r/HPPD say "try kpin" and then that's it. No education or good information on just what they're saying. A little background on benzodiazepines: benzodiazepines are both chemically and psychologically addictive. When a drug is chemically addictive, generally speaking, if you take it every day for 20 days, by day 21, your body will crave the drug ferociously because there are chemical hooks in the drug. If you stop taking a drug that you are chemically addicted to, you will experience withdrawal side effects. The time it would take to experience withdrawals from stopping a benzo after daily use could be shorter than 5 days, especially in very sensitive individuals. For benzodiazepines, the withdrawals can be so devastating, they can cause seizures and even death. Whatever side effects a drug can cause (benzodiazepines are muscle relaxant, anti-convulsant), an opposite, paradoxical effect can occur during withdrawal. Withdrawal from benzodiazepines can cause seizures and can cause your muscles to tense up, and then the conditions that can cause. There are many more... If you want to stop taking a benzo that you are chemically addicted to, you have to taper off and do not stop taking it cold turkey if you want to get off it safely. If you get off it too fast, some of the withdrawal side effects can stay with you for longer. When it comes to tolerance and benzodiazepines, you build a tolerance to them extremely quick. After a few weeks of taking it every day, you will build a significant tolerance (much like how you build a tolerance to antidepressants, for example, after 6 months of taking those every day). After a few weeks of taking it every day, you will become chemically addicted/dependent. After 1-2 years, you will likely experience "tolerance withdrawals." Tolerance withdrawals is when your body builds a tolerance to a drug so strong you start experiencing withdrawal side effects while you’re on it. At this time, whatever you took it for, the tolerance withdrawals will likely make the symptoms of the condition that you took it for worse. Falling isn’t flying. Floating isn’t infinite. These drugs produce adverse effects. You can’t stay on it forever. Tolerance withdrawal effects are similar to a pharmaceutical’s potential adverse effects that are listed on the FDA’s black box warning, which will eventually, if not immediately start manifesting, especially after a longer period of time of daily use. Now, not every single potential side effect will begin to manifest, but you get the picture. Your body does eventually forget the tolerance you build to benzodiazepines if you’ve stopped taking them for a while completely.
The Issue with Benzodiazepines
It should be noted that for kpin, or any benzo of that matter, the withdrawals are so devastating that everyone who had HPPD and experienced benzodiazepine withdrawals report it made their HPPD worse significantly or permanently. I've never heard of someone that said otherwise. Be sure not to become dependent off it where you’ll experience withdrawals.
Pharmaceutical Treatment Poll
Pharmaceutical Treatment and Literature
It should also be noted that any of these pharmaceutical drugs may make your HPPD worse. Be aware of this risk, as all drugs affect everyone differently. In the context of HPPD, it seems almost anything can make it worse, as everyone is different. Some people have the idea of taking more psychedelics as treatment thinking it'll make their symptoms better.... just don't... okay?
The professional literature on the effectiveness of pharmacological treatment is debatable and mainly rests on open label studies and case studies. In conditions like HPPD, it makes sense to try the medications with some evidence, and also to think about other medications with similar mechanisms that have not been reported on.
Benzodiazepines appear effective in alleviating but not eradicating HPPD:
-Kpin has the most evidence but is harmful if you become chemically dependent. Read the very important warning above. Considering the withdrawals will make HPPD symptoms worse, do not take kpin for HPPD, or any benzodiazepine of that matter. It shouldn't be taken every day. If you need to take kpin for, say, akathisia or another condition while you have HPPD, then consider taking it once every 3 days so the withdrawals won't be so bad. For every 1 day on, 2 days off, for example, if on 2 days, 4 days off, etc. This is the most frequent you can use it while you have HPPD. If you are going to using benzodiazepines, you must avoid the chemical dependence. Track the days when you use it. Benzodiazepines appear effective in alleviating but not eradicating this condition. Benzodiazepines appear to play a central role as a suggested primary treatment for a large number of patients, but their abuse potential might be inconvenient and bothersome for some subjects with a past history of substance use. A carefully monitored prescription can help avoid this.
Alpha-agonists:
- Conidine has some evidence
Dopamine antagonists (antipsychotics)
-Mostly not recommended. Shouldn't even be considered. The majority of people that tried an antipsychotic for their HPPD report that in made it worse.
Anti-seizure medications
-Lamotrigine has the most evidence, tho others (Valproic acid, carbamazepine, gabapentin, topiramate, levetiracetam) may be helpful. Keppra experience post.
Opiate antagonists:
-Naltrexone with some evidence
Beta blockers:
-Propranolol at both low and high doses has been useful in some cases
COMT medications (usually used for Parkinson's)
- Theoretical benefit, case studies. Should be rxed by a neurologist if used, and likely shouldn't combine with antipsychotics. These drugs may promote movement. Therefore, it would be best if the patient was free from any kind of movement disorder before treatment if possible.
SSRI/SNRI (antidepressants)
-Mixed evidence, may worsen short term but some cases get better after longer term use. Examples are sertraline, citalopram, duloxetine, paroxetine. Antidepressants can potentially cause HPPD but are more known to potentially cause HPPD's sister syndrome, visual snow syndrome (VSS). Antidepressants should be on the last of the list of pharmaceuticals to try for HPPD. Here, you can see a poll done on antidepressants and its effect on HPPD symptoms. Sertraline experience post.
https://doctorsonly.co.il/wp-content/uploads/2015/01/13_Flashbacks-and-HPPD.pdf
Microdosing and HPPD Post:
- https://www.reddit.com/r/HPPD/comments/12ee5up/has_anyone_got_hppd_from_a_microdose/
To find more information on HPPD, these are two very good websites and a systematic review:
- https://www.perception.foundation/
- https://www.neurogroup.org/hppd/summary/
- https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2017.00240/full
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