MAPS: PHPD (was: Aftermath of a very bad trip)

[James Kent <jamesk_@xxxxxxxxxxx>]

In the past few years I have received a handful of e-mail messages from 
casual psychedelic users all suffering from extended after-effects of a 
recreation trip gone bad. Although the substances differed (LSD being most 
common, followed by Ketamine, mushrooms, and 5MEO-DMT) the effects of the 
disorders where the same. They are: mild perceptual disorders such as a 
strobing or pulsing effect in ambient light and some mild hallucinations 
when staring at textures and patterns; a mild sense of dizziness and/or 
disorientation; a persistent headache located either between the eyes or 
slightly off to one side of the head; and a persistent sense of anxiety and 
hopelessness. I have heard these symptoms referred to as PHPD (Post 
Hallucinogenic Perceptual Disorder) in the literature, and in all cases in 
which I was approched the subjects were *positive* they had fried their 
brains for good.

> From what I can tell, the subjects all seemed to reach a peak of 
hopelessness and anxiety around week two of the persistent effects. Some 
tried to fight it with heavy drinking and/or marijuana use, but that just 
exascerbated the situation. One tried to treat it with a "cleansing regimin" 
of frequent aerobic excercise, fasting and healthy dieting, lots of water, 
and long saunas. I all cases the symptoms persisted for around 3-4 weeks and 
then began to slowly taper off. By the end of week 6 most were back to 
normal, with the exception of one subject who spent nearly 16 weeks in this 
state before it started to subside (or at least I'm guessing it did since he 
seemed to be feeling better and I never heard back...).

I all cases (without exception) the incipient event was an extremely bad, 
emotionally challenging trip which just wouldn't end. The intensity of the 
trip waned over the natural course of the usual dose durations, but the 
anxiety of 'no solid resolution' to the bad trip resulted in persitent minor 
perceptual disorders and anxiety which  affected sleep patterns, social 
interaction, and basic concentration.

Without having any hands-on analysis of the subjects it is hard for me to 
draw any conclusions as to what the source of PHPD is, but I am guessing 
that in most cases it is caused by the combination of an pre-exsting 
emotional truama coupled with a neurochemical imbalance brought on by the 
trip (depletion or surplus of some neurochemical). The fact that all cases 
returned to "normal" over the course of a few weeks leads me to believe that 
there are corrective mechanisms which can adjust to these intense freakouts, 
it just takes a while for them to fully recover to baseline.

I have also heard anecdotal evidence which would suggest that "going back 
in" and re-dosing with the same substance to confront and resolve the 
unresolved issues can be beneficial to interrupting the PHPD cycle, but most 
subjects tend to be deathly afraid of this possibility fearing that further 
damage may be incurred.

I have never heard of a single case of permanent PHPD in otherwise 'normal' 
individuals, but then again I am no expert. If anyone on the list knows of 
such cases I would very much like to hear about them.


James Kent




> From: "K. Thomas Nelson, Ph.D." <nelsontx@xxxxxxxxxxxxx>
> Reply-To: "K. Thomas Nelson, Ph.D." <nelsontx@xxxxxxxxxxxxx>
> To: <maps-forum@xxxxxxxx>
> Subject: MAPS: Fw: Aftermath of a very bad trip.
> Date: Sat, 29 May 1999 22:29:51 -0700
>
>
> -----Original Message-----
> From: K. Thomas Nelson, Ph.D. <nelsontx@xxxxxxxxxxxxx>
> To: Fenwizard@xxxxxxx <Fenwizard@xxxxxxx>
> Date: Sunday, April 11, 1999 1:46 AM
> Subject: Aftermath of a very bad trip.
>
>
> I am I clinical psychologist in Arizona who has had occasion to evaluate 
> several hundred people (in jail or in our county acute-care psychiatric 
> unit) who have suffered from bad aftermaths of various hallucinogenic and 
> stimulant drugs. I do not believe that any psychedelic ordinarily "causes" 
> a major psychiatric disorder althought long "runs" of methamphetamine can 
> and do cause lasting paranoid psychoses which often outlive the presence of 
> the drug in the body by weeks or months.  The treatment of choice among 
> psychiatrists for such a condition is usually a brief trial on a 
> neuroleptic (e.g. Resperidal, Olanzapine).  Unless the person is 
> predisposed to an emerging psychosis, the neuroleptic usually does the 
> trick.
>
> For acute bad trips (which usually amount to an anxiety reaction), the most 
> knowledgeable psychiatrist I know uses only anxiolytic (eg Valium, Ativan) 
> drugs.
>
> The only other case of long (>1 week) psychedelic induced psychosis I know 
> of is described by Terence MacKenna in "The Invisible Landscape."  McKenna 
> attributes this to  "irreversable" MAO-Inhibition.  It is reversable but 
> takes about 10 days to two weeks reverse itself which is about how long it 
> took Dennis and Terence MacKenna to recover, according to their book.
>
> To focus upon your Finnish friend, I would hasten to point out that 
> psychedelics (as well as many other classes of drugs DO have the potential 
> to facilitate the emergence of an underlying psychiatric or emotional 
> problems which may never have previously manifested themselves, just as 
> crises later in life tend to resurrect earlier unresolved issues including 
> buried trauma.  The fact that your friend was abused as a child suggests to 
> me that he had a rapid and overwhelming emergence of  a Post-Traumatic 
> Stress Disorder during his trip.  Therapists who are attempting to help 
> people with PTSD recover usually use techniques which evoke the earlier 
> trauma in smaller more processable segments so that the patient can work 
> through the trauma and not be overwhelmed.  Overwhelming reexperience of 
> trauma usually results in dissociative experiences which are not helpful in 
> resolution of the PTSD.  I think this is the idea behind "psycholytic" as 
> opposed to "psychedelic" (high dose) therapy.
>
> Please reassure your friend that he is not psychotic.  He seems to be 
> experiencing some perceptual abnormalities, but everthing that you have 
> said suggests to me that his reality testing is very much in tact and that 
> he is capable of thinking logically.  He does not appear to be harboring 
> delusions, either.  I doubt that the unpleasant effects he is eperiencing 
> are the effects of the drug or of any lasting organic brain changes brought 
> on by the ingestion of Psilocybin and Syrian Rue.  First, these substances 
> are probably long gone from his body, and secondly, I know of no reseach 
> suggesting the either drug causes organic brain damage, although I must 
> admit my knowledge in this area is far from exhaustive.
>
> Please encourage your friend to seek psychotherapy for PTSD (focusing on 
> the child abuse) and to shop around for a therapist he has confidence in.  
> Many modalities are available including dynamic psychotherapy, EMDR, drug 
> treatment for anxiety or even psycholytic therapy (where permitted by law.)
>
> By all means give your friend my email address; it would be a priviledge to 
> help in some small way if I am able.  Tell him I'm an ethnic Finn, too.  
> And email me yourself if you think I can answer any questions.
>
> Tom Nelson, Ph.D.


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