Trapped Behind The Looking Glass: A Case Of Hallucinogenic Persisting Perception Disorder With Response To Prazosin
Hallucinogens have made a comeback, both recreationally and in the medical field. Discussions of microdosing LSD for depression or ayahuasca for addiction seem unavoidable in the mainstream. Recreationally, hallucinogens have been used by 15% of Americans in their lifetime (SAMSA) and by 1.9% of the population within the last year. Many users cite hallucinogens as being a powerful tool for expansion of the mind and spirit. However, with any substance there are risks and potential side effects. Familiar to many under the propagandized term "flashbacks", hallucinogen persisting perception disorder (HPPD) is a rarely encountered DSM5 diagnosis that can cause significant impairment and distress in hallucinogen users. As the name indicates, patients who suffer from HPPD have enduring perceptual disturbances long after they are no longer under the influence of a hallucinogen. Literature on HPPD is sparse, and no definitive treatment exists. What follows is a review of HPPD and a case report of a young man who ingested a large amount of lysergic acid diethylamide (LSD) over the course of two months and developed persistent changes in both vision and hearing. The most distressing symptom being the appearance of "the walls breathing" almost constantly, every day. The patient was diagnosed with PTSD and treated with prazosin for nightmares and somatic symptoms of anxiety unrelated to his drug use, incidentally reporting dissipation of the perceptual disturbances. This appears to be a novel use of prazosin; however further research is necessary.