Hallucinogen Persisting Perception Disorder Following Recreational Dextromethorphan Use

Hallucinogen persisting perception disorder (HPPD) is a rarely diagnosed condition involving ongoing sensory disturbances after hallucinogen use, with unknown cause and no established treatments. A 20-year-old male developed HPPD after repeated recreational use of dextromethorphan at supratherapeutic doses, experiencing visual snow, motion trails, afterimages, halos, tinnitus, depersonalization, and derealization. Antipsychotic medications worsened his symptoms. Treatment with lamotrigine and clonazepam brought some improvement. Adding ropinirole, a dopamine agonist, further reduced visual disturbances and made him feel better, but he eventually stopped all medications due to side effects. The case suggests ropinirole may be a novel treatment option for HPPD, though more research is needed.

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Abstract

Introduction: Hallucinogen persisting perception disorder (HPPD) is a rarely diagnosed disorder characterized by continuous sensory disturbances following the use of hallucinogenic substances. Its cause remains unknown, and treatments remain elusive, although previous case reports have detailed attempts at treatment with a variety of psychoactive medications. No previous case reports have discussed the emergence of HPPD following dextromethorphan use, or its treatment with ropinirole. Case: We present the case of a 20-year-old male who developed HPPD after repeated recreational dextromethorphan use at supratherapeutic dosages, leading to the acute onset of visual snow, motional trails, the persistence of afterimages, the perception of halos around lights, tinnitus, and depersonalization and derealization. The client found these symptoms to be greatly distressing, and he had worsening of symptoms when treated with antipsychotic medications. After he was treated with lamotrigine and clonazepam, he had some improvement of symptoms. To treat additional visual symptoms, the patient was given ropinirole, a dopamine agonist, which made him feel better with less visual disturbances. Ultimately he had to discontinue all medications due to intolerability to side effects. Conclusions: The lack of effective treatments for HPPD and a general lack of awareness among patients and providers leads to underdiagnosis and incorrect management. Ropinirole may offer a novel treatment for patients with HPPD, and more research is needed to determine the suitability of dopamine agonists in the treatment for HPPD.