John H. Halpern, Harrison G. Pope, Jr
http://www.erowid.org/archive/rhodium/pdf/hppd.review.pdf
Read ^
Of particular relevance...
"After excluding these types of cases, we are left with a
core of ‘strict’ HPPD cases, where a neurological or
psychiatric diathesis in some individuals leads to persistent
visual phenomena long after hallucinogen exposure.
The mechanism of these cases
remains uncertain. Abraham
et al. (1996), for example, hypothesizes that HPPD
is a
‘‘disinhibition of visual processing related to a loss
of serotonin receptors on inhibitory interneurons’’."
Serotonin, the primary neurotransmitter of digestion, is an inhibitor and moderator of MANY brain functions.
Your intestines are literally wired to the entire brain, more densely than ANY other neurotransmitter system.
It impacts the flow of blood, the the consumption of glucose, the dispersal of acetyl-choline, the transmission of dopamine, and the firing of many types of neurons.
The visual cortex in particular is a very dense region of serotonin innervation, which also means a dense supply of blood vessels.
Compared to other senses, a rather LARGE portion of the cortex is devoted to sight.
From George Hatzidimitriou, Una D. McCann, and George A. Ricaurte
http://www.jneurosci.org/content/19/12/5096.full
"Seven years after MDMA treatment, 5-HT axon density remained decreased in all neocortical regions examined (Fig. 1, Table 2), although there was significant recovery relative to the 2 week survivors. In general, all neocortical cell layers appeared equally denervated. However, in the primary visual cortex and occipital cortical regions, the
largest reduction in fibers was evident in layer IVC.
The decrease in density of layer IVC is such that it is no longer discernible as a distinct layer in MDMA-treated monkeys after a 7 year survival period (Fig. 1). "
The last sentence is referring to the fact that this particular layer of the visual cortex is quite impressive in its serotonin density (in control monkeys). The loss of density is so severe and long-lasting that this layer is not 'discernible' as a serotonin-rich layer compared to surrounding layers.
Make sense?
What the seven year study proves is that when a truly TOXIC dosing regimen is administered to a primate brain - the visual cortex contains a portion of serotonin nerves that are more vulnerable. And unlikely to recover...
This does not necessarily translate to
human HPPD cases.
But it is a very good candidate for explanation.
Although it is believed that human brains are MORE vulnerable to MDMA neurotoxicity than other primates, the dosages given in this study were very high.
To be precise....for a person weighing 70kg the equivalent dose would be 350mg of pure MDMA taken TWICE per day (9AM and 5PM).
Four days in a row.
Injected!
That is 2.8 grams of MDMA stretched out over four days.
So you can imagine this is a pretty heavy 'binge' model that most people simply never attain.
Most...
Yet it provides us with data that shows the visual cortex is vulnerable to neurotoxicity - perhaps even at lower doses.
When damage does occur, you can bet that this region will be affected.
Other studies on MDMA have shown that the visual cortex experiences an up-regulation of 5HT-2B receptors, perhaps as a compensatory mechanism following the loss of other receptor types. The 2A and 2C receptors are believed to be directly responsible for the visual effects of LSD and mushrooms. LSD has 100 times more affinity for the 2A receptor than psylocibin and a MUCH higher rate of 'flashbacks' or HPPD.
Few studies of MDMA-induced HPPD exist.
I have read and personally experienced the following visual phenomena post MDMA and Serotonin Syndrome:
The world seemed slightly distant.
This is hard to describe in words, but it seems more accurate to say that
I was more distant from the world.
Like my eyes were set back in my skull - at least six inches.
Not only was I further away from what I was seeing, but colors seemed drained of their richness and textures robbed of their definition.
My eyes could hardly focus on things far away, and switching between close and distant was very disorienting.
More importantly than what I described above, the world seemed to be hidden behind a nearly invisible sheet of glass.
Or maybe it looked like everything I saw was playing on a movie screen - projected from a distance behind me.
'Dream-like' doesn't quite capture it, but it will have to do.
It was the type of thing that one might expect to induce a sense of euphoria, yet this is far from truth.
No - this new existence was cold, hollow, dry.
Empty.
Human beings were very strange to look at.
They seemed two-dimensional -
card-board like.
Yes, two dimensional card-board cut outs with faces that I couldn't understand.
I didn't want to look at faces or to see mouths speaking.
The neurons that distinguish faces simply were NOT working for me.
And facial expressions were completely unnoticed.
I avoided eye-contact at all times, preferring to look down at the floor like an abused child.
Odd - I have heard the EXACT same thing from people withdrawing from SSRIs.
Looking at faces seems to be such a challenge that one instinctively avoids them.
I remember forcing myself to tolerate this condition - to look directly at the face of my wife.
To speak with her. And the same with neighbors.
With great effort, I was able to overcome this lack of visual perception.
I could see facial expressions and I could remember what they meant.
I could see colors, at least to know they were there.
Textures required greater concentration - eyes too lazy for such things.
Yet it was obvious, my brain was drawn away from distinguishing these images.
It was like a magnet being repelled - I could force it, but only with continuous effort.
This is how things were for the first four weeks.
I was CERTAIN that I was getting a preview of what the world looks like to an elderly person.
Yes, a 90 year old man would see the world this way.
But I was 28.
Absolutely terrifying...
Then I discovered Piracetam, after four weeks of suffering.
Within an
hour of my first dose I felt the change.
My stomach came back to life!
I felt the warmth of fluids rushing from the stomach to the small intestines.
I felt my metabolism increase.
For the first time in a month I emitted body odor from my armpits.
And I could feel my genitals again!
And the bottoms of my hands and feet.
Then I realized my vision was improving too.
Yes, by the second dose I knew it was happening.
Colors flooded back into vibrancy!
Textures regained their definition.
I could see the pores and freckles on my beautiful wife's face, and it SHOCKED me.
Almost like I had forgotten such things existed...
To say that I felt relief is a vast understatement.
I was a man reborn.
Resurrected.
In a matter of hours I went from the greatest emptiness to absolute salvation.
I cried tears of joy.
I would later learn that Piracetam preferentially increases serotonin and dopamine in higher brain regions.
I also learned that I required VERY small doses to maintain the positive change.
Only the first three days of dosing provided the euphoric and incredible emotional response that I felt.
After this continued use simply maintained the feeling of 'normal'.
Ok, there was incredible mental stimulation - as evidenced by my excessive reading and posting on BL.
But the emotional transition was temporary.
The benefits were not - my HPPD and anxiety and depression all subsided.
As long as I continued taking 100mg or so every day my salvation continued.
I concluded several times in the following few months that my recovery was 'almost complete'.
Exercise was already giving me incredible relief, even before piracetam was introduced.
I actually had cycles - 5 days of horrible soul-destroying suffering followed by 2 days of being absolutely 'normal'.
It was the Piracetam that interrupted these cycles.
About three weeks into taking it I realized I was getting mild headaches.
More than this, I started feeling overstimulated by it. Almost jittery.
So I stopped cold-turkey.
The first few days of withdrawal actually made me feel BETTER.
It was like my neurotransmitters were re-aligning on their own.
The euphoria and mental clarity got better.
Then the worst thing I could imagine happened - color started draining from my world again.
It took less than a week to realize that Piracetam was no cure.
Its effect, although incredible, was temporary.
The emptiness consumed me.
I could not believe how far I fell.
The worst part was that it was insidious - it came from within.
It was a slow descent, but it didn't stop.
I knew that I couldn't live without the Piracetam.
And the return of HPPD was the clearest indication of this.
I would cycle on and off my miracle supplement until 6 months post MDMA, never spending more than two horrible weeks without it.
At six months I got a new job and decided I had to disconnect from my research and writing.
Focusing on something else, getting on with my life (like everyone says on BL) must be the key.
Right?
Hardly.
While it must be done, returning to normal life is NOT a cure for the condition.
Suffering and emptiness persists.
And quitting cold-turkey again meant the most HORRIBLE head-pressure that I ever experienced.
My sinus and eyeballs were being pushed right out of my skull!
I am certain I experienced my first strokes, or TIAs, at this point.
But I was determined to remain off the powder.
Oddly, the brightness of colors surged forth that week.
During the worst of my head-pressure the colors were brightest!
I think I made it a whole month before giving up and jumping back on the Piracetam.
I would try again after a month on it - believing that one day the descent would be survivable.
By month 7 I had a real stroke - feeling my entire right arm go numb.
Fortunately it lasted minutes and I recovered.
I believe this is one of the things that allowed me to truly step away from the stuff.
It was like a pressure release valve.
I made it to 100+ days before I gave up the next time.
I really thought that I was going to keep off of it, but eventually I was forced to admit I wasn't ready.
Exercise, healthy diet, sleeping, fucking, working, living....none of this was enough.
It wasn't until 13 months had passed that I stepped away for good.
I was determined to endure whatever might happen.
That is when I truly started to change cognitively.
Months 14-17 caused real changes in cognition and personality - until then I was the 'old' me in a state of intense suffering.
But during this period of time I was becoming somebody different.
I was no longer 'me'.
And this is why the suffering stopped.
I was adapting my cortical neurons to the new serotonin structure.
Reading and writing became very challenging.
This was a sad time for me, because I held onto my intellect like a lifeline during the first year.
I couldn't believe that it was slipping away, changing.
My vision also became VERY stable.
The worst of the HPPD stopped by month 6 - colors, textures, facial expressions...all OK. Not great, but ok.
But I could tell that my eyes were not aligned with each other - like an astigmatism, the two images were not stitched together correctly in my brain. Forcing my eyes to focus on an object right in front of my face would make me dizzy! So I did it thinking it would help.
It wasn't until after the one year mark that the 'astigmatism' effect had nearly vanished.
I was glad to say that the vision I was left with by the 18 month point was quite acceptable - I would gladly live with it for the rest of my life.
Even now I have intermittent difficulty focusing on words, but the deterioration seems to have stopped.
And most days I can read and write just fine, although I am more likely to make spelling mistakes without noticing.
My fingers don't seem to know the keyboard as perfectly as they used to - but this is not the case right now.
I said intermittent for a reason.
Many days my vision seems 99% perfect.
The tiny 1% might balloon to 5% on bad days, a couple times per month.
This abstract description of my HPPD is meant to communicate to the other HPPD suffers in this thread one basic thing.
If my horrible case of HPPD can reach this level of resolution, then SO CAN YOURS.
Despite the research showing loss of visual cortex innervation after seven years...
I can truly say that the overall quality of vision is not greatly affected.
If anything it is the meaning of what I see, the emotional impact of certain things (sunsets, landscapes, naked women) that seems altered.
And even these things are slowly returning to normal.
HPPD is NOT permanent.
Even Halpern's review of countless old studies on LSD find that most cases of HPPD last weeks to months.
Considering how powerful the visual effects of LSD versus MDMA, it should be concluded that MDMA holds a relatively small risk of long-term visual change.
In all my reading I found only two case reports showing hallucination or HPPD in abstinent MDMA users post 3 years.
I cannot find them or I would post them, but both were very heavy MDMA and poly drug users.
One was a female reporting 'spiders' in the shadows after four years of recovery, and this was very distressing to her.
Many other anecdotes seem to indicate visual snow or 'floaters'.
I got mild snow and 'static' but only after month 7 when I really stopped the Piracetam.
And it was mild and almost enjoyable to see...
And then it stopped.
Regardless of the exact type of HPPD, it simply tends to resolve itself.
This is very important to believe when you are experiencing it - because it is natural to believe your new reality is 'permanent'.
After all, waking up to the nightmare every morning sure enforces the thought of permanent damage.
Just remember, your intestines are still working.
The contraction of smooth muscle tissue around the body is constantly changing the innervation of serotonin in the brain.
This is a VERY long-term process and the brain will never stop adapting.
I hope this helps littlestar.
My HPPD was BAD.
And now its GONE.
FBC
