Hallucinogen Persisting Perception Disorder (HPPD) Management

Treatment Options

Benzodiazepines, particularly clonazepam, are the most effective first-line treatment for controlling symptoms of HPPD, with superior efficacy compared to low-potency benzodiazepines 1
Sertraline may be considered for comorbid depression or anxiety in patients with cardiovascular disease, as it appears to have a lower risk of QTc prolongation, according to the American College of Cardiology 1
Tricyclic antidepressants and monoamine oxidase inhibitors should be avoided due to significant cardiovascular side effects, as suggested by the American Heart Association 2

Low-dose quetiapine (12.5-200mg) may be effective for anxiety and paranoia symptoms that may accompany HPPD, although some case reports suggest antipsychotics may worsen symptoms in certain patients 1, 3
Caplyta has a lower risk of extrapyramidal symptoms compared to typical antipsychotics, as noted in the American Family Physician 3
SSRIs, such as Trintellix, are effective for major depressive disorder and may have additional benefits for cognitive symptoms in depression, as well as social anxiety disorder, as recommended by the field of Neuropsychopharmacology 3, 4

Regular assessment of visual symptoms and their impact on quality of life is essential for effective management of HPPD 1
Screening for comorbid anxiety and depression, as well as monitoring for medication side effects, particularly sedation with benzodiazepines, is crucial 1
Regular metabolic screening (every 3-6 months) is necessary, including blood glucose, HbA1c, lipid panel, weight and BMI, and blood pressure, with careful monitoring of cardiovascular health, including ECG at baseline and periodically, especially with Caplyta and Seroquel 3
Tardive dyskinesia screening every 3-6 months (AIMS assessment) and monitoring for signs of neuroleptic malignant syndrome and emergence of extrapyramidal symptoms are crucial 3
Regular assessment of depressive symptoms, anxiety levels, ADHD symptoms, paranoia and psychotic symptoms, and borderline personality features (impulsivity, mood instability) is necessary to ensure comprehensive coverage of the complex presentation 3

Discontinuing hallucinogen use is essential for symptom improvement, as complete abstinence from hallucinogens is necessary for recovery 2
Cannabis cessation is also recommended, as cannabis and synthetic cannabinoids can trigger or worsen HPPD symptoms 2

The combination of Caplyta, Lamictal, Trintellix, and Seroquel requires careful monitoring as multiple CNS-active medications are being used, and avoiding adding other serotonergic agents due to risk of serotonin syndrome is essential, as noted in the American Family Physician 3
Low-dose quetiapine (25mg) as needed is appropriate for breakthrough anxiety 3