Shaolin, I'll be happy to put on a dunce cap and strum my lips while making semi-mammalian noises in a very public place and then post the video on you tube if we can break out of the circularity here.
Perhaps if I can see the Abraham paper, or any paper (whether it comes from Harvard or from the North Korean Ministry of Defense or from some guy named O-Dog) anything that explains or attempts to explain the pathophysiology of HPPD.
I'll go first, simply using Offerman's Encyclopedia of Molecular Pharmacology:
First the obvious:
The most widespread extraclinically
used psychostimulant is ecstasy (3,4-methylenedioxymethamphetamin;
MDMA), which also exhibits perceptual
distortions due to 5-HT2A-receptor agonism like
lysergic acid diethylamide (LSD).
So then, your (or Abraham's) claim is that hallucinogens damage this selfsame 5-HT2A pathway by permanently eliminating many of those receptors in specific areas of the visual cortex. This immediately prompts the question, "If the primary pathway is cut off, how can the hallucinogens' symptoms recur?"
So then, the claim is that the hallucinations et al of HPPD are not caused by the 5HT2a pathway, but rather by a critical lack of GABA molecules in the relevant synapses and the consequent hyper-exitation. It is also claimed that benzodiazepine drugs (especially clonazepam) ameliorate the symptoms of HPPD. This sets up a contradiction:
At a given concentration
of GABA in a synapse, the chloride current will be
increased. Benzodiazepines have no action in the absence
of GABA (use-dependence) and cannot increase
maximal physiological stimulation by a high concentration
of GABA, i.e. their action is self-limiting, which
most likely contributes to the safety of these drugs with
respect to overdoses.
Also, it's claimed that the reason there's a decreased GABA concentration in the synapse is that since the 5HT2A's are decimated, pre-synaptic GABA release is insufficiently stimulated. This assumes that one of the principal catalysts of presynaptic GABA release is serotonin activity, principally at the 5-HT2A receptor. I don't know enough about triggers for GABA release, but I assume the triggering has something to do with all exitatory transmitters; if so, the hypervigilance and anxiety which accompany flashbacks (to call a steer a steer) are necessarily the products exitatory transmitters and depolarization. So then, given all that's been said about GABA release, there seems to no dearth of triggers. This is speculation on my part. Offerman only gives me this:
GABA...is synthesized in
presynaptic terminals from glutamate by the action of
the enzyme glutamic acid decarboxylase, stored in
vesicles and released upon the arrival of an action
potential.
One or two of us is oversimplifying or overlooking key aspects of the process. Either that or the 5HT2A-receptor-attenuation theory is incomplete. I'd really like to see that Abraham paper.
I'm keeping this up because I honestly want to know, not because I think you're wrong.