LSD and Its Connection to HPPD

Psychedelic drugs are often classified as a subclass of the hallucinogens that result in altered perceptions and cognitions in individuals who take them. These drugs have an effect on the neurotransmitter serotonin and other neurotransmitters in the brain. These drugs were extremely popular in the 1960s and 1970s. They may be making somewhat of comeback today, although they have not approached the popularity they had decades ago.

This article will discuss the psychedelic drug LSD and its relationship to hallucinogenic-induced persistent perception disorder (HIPPD).

LSD

LSD is an abbreviation for its chemical name, lysergic acid diethylamide. LSD is capable of producing very realistic and vivid hallucinations (mostly visual) and extremely strong changes in mood in individuals who take very small amounts of the drug. There is quite a range of sensory perceptual experiences and mood states that occur in individuals who take this drug, and it most likely interacts with the individual’s expectations, past experiences, and biology to affect individuals in personalized manners. Users typically take very small amounts in a liquid form that can be ingested with certain types of edible papers or in a tablet form.

The drug was originally developed by a Swiss chemist named Albert Hoffman back in 1938. Hoffman was attempting to use different types of substances to assist in childbirth and was concentrating on the use of a fungus known as ergot for this purpose. He developed a number of different compounds, and LSD was the 25^th of these compounds (its original designation was LSD-25). Hoffman was looking to develop the stimulant properties of the drug, but it did not meet his specifications and he abandoned his study of it until five years later. While working with the drug at this time he began to have visual hallucinations, a sense of euphoria, and dizziness. The following day he administered a small amount of the drug to himself (250 micrograms, which is actually a large amount of LSD to take). He became euphoric and experienced a number of different pleasant visual hallucinations. After administering it to other individuals in his laboratory group, he decided to market the drug as a therapeutic drug to psychiatrists.

The drug became quite popular in the 1960s and was responsible for a counterculture movement looking for various aids to enhance thinking and to expand consciousness. The compound was also used for treatment purposes in psychiatry, and some sources still report that it can be useful in the treatment of certain individuals. The drug eventually lost popularity due to a number of changing issues in the 1970s, including more conservative values regarding drug use.

Currently, the United States Drug Enforcement Administration (DEA) has LSD listed as a Schedule I controlled substance, which indicates that, according to the DEA, the drug has no medicinal uses and a high potential for abuse and the development of physical or psychological dependence (despite evidence to the contrary).

How LSD Is Used by Casual Users

As mentioned above, LSD is a hallucinogen, fitting into a class of drugs that include other mind-altering drugs such as mescaline, PCP, and psilocybin (the ingredient in magic mushrooms). Individuals take the drug for its hallucinogenic and mood-altering effects. It is typically taken in very small doses between 100 and 200 micromilligrams. Even at such small doses, the effects can be long-lasting, and in some individuals, they can last for up to 12 hours. It is taken in pill form or ingested as a liquid on edible papers.

There are a number of case reports that indicate that even at extremely high doses, there are no serious physical long-term effects of LSD use. The majority of individuals in these studies experienced decreased respiration, increased body temperature, gastrointestinal issues (nausea, vomiting, or light bleeding in the intestine or stomach), and, in rare cases, unconsciousness, but all symptoms were readily addressed.

According to these studies, it does appear that individuals do develop tolerance to LSD, but there are no significant withdrawal symptoms, indicating that despite the classification by the DEA, the drug is not associated with a significant potential for the development of physical dependence. LSD does not appear to be a drug that is associated with high rates of diagnoses of substance use disorders (abuse and addiction), although there are certainly instances were individuals abuse the drug. Despite this, there are dangers associated with using the drug.

Long-term Effects, Bad Trips, and HIPPD

Despite a relatively innocuous body of research looking at the long-term effects of LSD use, there are some reports in the research literature that suggest the potential for issues.

• Changes in mood: There is evidence that chronic use of hallucinogens such as LSD may lead to long-term changes in mood, including formal diagnoses of issues with depression or anxiety disorders. Chronic users of hallucinogenic drugs like LSD were noted to have issues with motivation and achievement compared to individuals who do not use these drugs; however, it is unclear whether these represent pre-existing tendencies or the effects of chronic use of these drugs.
• Under the influence: There is a potential that an individual under the influence of LSD could harm themselves, as their hallucinations may lead to issues with poor judgment or getting involved in accidents. Additionally, individuals under the influence of the drug may experience changes in mood that are potentially distressing to them. This could include the development of LSD psychosis that occurs when an individual under the influence of the drug loses contact with reality. Some individuals may experience panic, depression, issues with distressing hallucinations, and delusional behavior, including paranoid delusions. There does not appear to be a very strong link between having these experiences under the influence of LSD and developing a formal psychotic disorder (e.g., schizophrenia).
• Bad trips: There is no guarantee that using LSD will result in a pleasurable experience. The drug alters an individual’s perceptions, awareness of their surroundings, and even their sense of time. Individuals may experience a number of different emotional states in rapid succession that can include joy, happiness, sadness, despair, anxiety, etc. In some individuals, their sensory perceptions may seem mixed such that they believe they can hear colors and see sounds. These experiences may be quite frightening and distressing to some individuals and result in severe depression, panic, or worse. The potential to experience bad trips under the influence of LSD can be decreased by using the drug with a trusted confidant, remaining in a secure environment, and avoiding use of the drug when one is depressed or under duress. Individuals who have numerous bad trips may be at risk to develop flashbacks.
• Flashbacks: Flashbacks occur when individuals who have not taken LSD for some time suddenly start having the experiences of being on an LSD trip without using the drug. Different sources indicate that the experience of flashbacks may be relatively common. Estimates range greatly; sources say that 5-50 percent of individuals who use hallucinogenic drugs experience at least one flashback. Individuals experiencing more than one flashback that results in significant distress for them may develop a defined mental health disorder known as hallucinogenic-induced persistent perception disorder (HIPPD).

HIPPD

The most common experiences of individuals having flashbacks are visual experiences, including seeing flashing lights, seeing different colors, seeing halos on people or objects, and other rather innocuous visual hallucinations. However, since flashbacks only occur when individuals have not used the drug, these experiences may be very distressing. Having one or two flashbacks is not the same as having HIPPD. An individual diagnosed with HIPPD has a defined clinical disorder that satisfies certain diagnostic criteria (see below). HIPPD is relatively rare and appears to occur in slightly over 4 percent of individuals who have used hallucinogenic drugs.

An HIPPD diagnosis requires the following:

• Sometime after using the hallucinogenic drug, the person reexperiences one or more alterations of perception that they experience while under the influence of the drug. These can include a number of different potential perceptual changes, including afterimages, trails of moving objects, intensified colors, flashes of colors, objects seeming to be extremely small or large, etc.
• The re-experiencing of these perceptual distortions results in significant impairment in the person’s functioning or in clinically significant distress.
• These experiences cannot be attributed to the direct use of drugs or medications or another mental health disorder (e.g., schizophrenia), and they are not better explained by some other medical condition, such as epilepsy.

The development of HIPPD is associated with both the flashback effect and a resulting effect on the person’s functioning or emotional wellbeing. There is very little understanding as to why this disorder develops in some people, and any potential causal factors are loosely described. There are a number of suggestions regarding the possible causes of HIPPD, including:

• Perhaps small amounts of drugs like LSD are stored in the body tissues in individuals who chronically use the drug, and these are later released over time, resulting in the flashbacks.
• Chronic use of LSD and other hallucinogens results in changes in neuroanatomy that result in these types of experiences.
• Interactions with other drugs or medications may trigger these effects in individuals who chronically used hallucinogens. There appears to be a very small number of individuals who have used antidepressant medications or alcohol being diagnosed with this disorder.
• Individuals with other mental health diagnoses appear to be in a higher risk for HIPPD if they had chronically used LSD previously. HIPPD appears to have significantly higher comorbidities (co-occurrences) with individuals who have been diagnosed with panic disorder, major depressive disorder, and alcohol use disorder.
• Some other predisposing factors that may be associated with the development of HIPPD include having significant past use of LSD, combining other drugs such as marijuana or alcohol with LSD, having a history of bad trips on LSD, and using certain prescription drugs.
• As is the case with many mental health disorders, it is suspected that there is a genetic interaction to the propensity to develop HIPPD, although no specific genetic links have been reliably defined.

There appears to be no definitive forms of treatment to address the symptoms of HIPPD, and at this time, there is no cure associated with this disorder. Some sources suggest that the use of anticonvulsant medications can help, whereas other sources suggest the use of benzodiazepines might be helpful. Because the disorder is relatively rare, there are no large-scale, randomized, controlled trials looking at the treatment utility of different medications and other approaches at this time. Individuals with the disorder are addressed on a case-by-case basis.

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