Mushrooms' Flashbacks: A Trippy Truth Or Urban Myth?

Magic mushrooms, or psilocybin, are a type of psychedelic drug that can cause hallucinations and distort a person's perception of reality. Psilocybin is the active ingredient in magic mushrooms and is classified as a hallucinogen. Like other psychedelic drugs, magic mushrooms can cause flashbacks, or transient, spontaneous recurrences of the drug's effects after a period of sobriety. Flashbacks are a clinically recognized phenomenon and are documented in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) as hallucinogen-persisting perception disorder (HPPD). While the exact prevalence of HPPD is unknown, it is considered a rare condition, and only about 4-5% of people who have used psychedelics report experiencing flashbacks.

Flashbacks are a recognised phenomenon

Psychedelic drugs, also known as hallucinogens, alter a person's perception of reality, making them see, feel, and hear things that are not real, or distorting their interpretation of what's happening around them. Psilocybin, the active ingredient in magic mushrooms, is a psychedelic drug. Therefore, magic mushrooms can cause flashbacks.

In a pooled analysis of six clinical trials, 13 out of 142 subjects reported reoccurring drug-like experiences, predominantly mild and perceived as neutral to pleasant. Flashbacks were mostly visual, lasting for seconds to minutes, and occurred within a week after the last drug administration. However, flashbacks can also happen months or even years after drug use has been discontinued.

While there is no recognised medical treatment for flashbacks, anti-seizure and epilepsy medications, benzodiazepines, antidepressants, and low doses of atypical antipsychotics have been studied for the treatment of HPPD. Calming or self-soothing activities like deep breathing, grounding techniques, and mindfulness can also help ease psychological discomfort and keep one in the moment.

Hallucinogen Persisting Perception Disorder (HPPD)

HPPD was first described in 1954 and was established as a full syndrome in 2000. It is recognised as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and ICD-11. The cause of HPPD is not fully understood, but research points to several possible factors. One hypothesis is that HPPD is triggered by deconditioning, meaning that once vision and other senses have been altered by hallucinogenic drugs, they become more likely to be altered again without the influence of drugs. Another hypothesis is that HPPD is related to post-traumatic stress disorder (PTSD), with symptoms developing when a memory is triggered by a similar environmental factor. There is also a correlation between the number of times a hallucinogenic drug is used and the onset of HPPD, with research suggesting that using hallucinogens 15 or more times is a risk factor for developing the disorder.

There are two types of HPPD: Type 1 and Type 2. Type 1 HPPD is characterised by brief, random "flashbacks" or visual disturbances that are typically mild and cause little emotional distress. Those experiencing Type 1 HPPD are usually aware that their visual changes are not real, although their sense of time may feel altered. Type 2 HPPD is characterised by persistent changes to vision, which may vary in intensity and can be long-term, disturbing, and pervasive. While flashbacks are a common symptom of HPPD, they are not as comprehensive as flashbacks associated with PTSD. With HPPD, only visual disruptions are experienced, while other senses remain unaffected.

The symptoms of HPPD can be treated, and prescription medications and relaxation techniques such as meditation, breathing, and yoga may reduce symptoms or shorten episodes. Lamotrigine, an antihypertensive medication, has been found to alleviate symptoms in some cases. Benzodiazepines such as Klonopin and Xanax can also be prescribed to slow down activity in the brain and the nervous system.

Treatment options for HPPD

Hallucinogen Persisting Perception Disorder (HPPD) is a rare clinical condition in which patients who have had previous exposure to hallucinogenic substances continue to experience perceptual distortions or hallucinations months to years after the initial substance use. While there is no one recommended course of treatment for HPPD, here are some options that have been explored:

Medication

The mainstay treatment for HPPD is pharmacologic management. Benzodiazepines are generally considered a first-line medication for treating HPPD. Clonidine, an α2 adrenergic agonist, has also been reported to alleviate symptoms in patients with HPPD. Other medications that have been explored include lamotrigine, an antiepileptic and mood-stabilizing drug, and clonazepam, a tranquilizer. Selective serotonin reuptake inhibitors (SSRIs) have been used to treat comorbid conditions such as depression, but they did not relieve HPPD symptoms and may even worsen them.

Cognitive Behavioral Therapy (CBT) and Attention Training

Cognitive Behavioral Therapy and Attention Training can help individuals with HPPD process the meaning of their condition and how it relates to general anxiety and stress, especially from the drug experiences that may have triggered the HPPD. Mindfulness practices can also be incorporated with CBT to encourage individuals to observe, challenge, and reframe their thoughts, staying grounded in their bodies and the immediate environment.

Lifestyle Changes

Lifestyle changes, such as regular exercise, a nutritious diet, adequate hydration, and quality sleep, can help improve overall mental and physical health and reduce anxiety. Additionally, avoiding enclosed and dark environments can be useful since visuals are typically more intense in these settings. Some individuals with HPPD have also found success in wearing tinted glasses, particularly blue or orange shades.

Repetitive Transcranial Magnetic Stimulation (rTMS)

Repetitive Transcranial Magnetic Stimulation targeting the right temporoparietal junction (rTPJ) has been explored as a potential treatment for HPPD. While it has shown efficacy in treating depersonalization and derealization disorders, more research is needed to establish its feasibility and efficacy specifically for HPPD.

Self-induced flashbacks

Flashbacks following the use of hallucinogenic drugs like magic mushrooms are a medically recognised phenomenon. They are characterised by the re-experiencing of the effects of the drug after the original effects have worn off. While flashbacks typically occur in the days or weeks following drug ingestion, they can also manifest months or even years later.

The experience of a flashback can be self-induced by thinking about previous hallucinogenic trips. While the causes of flashbacks are not fully understood, they are known to be triggered by certain personality profiles, such as those with high absorption, deep imagination, and dissociation. Additionally, visual triggers, such as changes in light, can induce distortions in visual perception, leading to flashback experiences.

While flashbacks typically subside on their own after discontinuing drug use, they can persist or cause significant distress in some cases. If this occurs, seeking professional help from a mental health expert is advised. Treatment options may include cognitive-behavioural therapies, anti-seizure medications, antidepressants, or low doses of atypical antipsychotics.

Triggers and side effects of HPPD

Hallucinogen persisting perception disorder (HPPD) is a non-psychotic disorder in which a person experiences apparent lasting or persistent visual hallucinations or perceptual distortions after using drugs, including but not limited to psychedelics, dissociatives, entactogens, tetrahydrocannabinol (THC), and SSRIs. HPPD is characterised by a reoccurrence of a hallucinogen drug's effects days, weeks, or even years after the drug was last used. These experiences are commonly called "flashbacks".

Triggers

There are several factors that can trigger an HPPD episode. Worrying about having an HPPD episode could make an individual more likely to experience one. Fatigue, stress, and lack of sleep may also trigger an episode. Additionally, simply thinking about hallucinations can trigger a flashback.

Side Effects

The flashbacks of HPPD are primarily visual and can make one feel as if they are reliving an experience from the past. These flashbacks are typically less intense and do not last as long as the effects one would experience when using hallucinogens. Unlike the immersive flashbacks that some people have after taking drugs, HPPD flashbacks are purely visual. Individuals with HPPD may experience blurred vision, size distortion, and bright circles.

HPPD flashbacks can cause feelings of uneasiness, anxiety, depression, panic attacks, and migraines. The lack of control over flashbacks can lead to feelings of uneasiness and anxiety. HPPD can affect the way a person perceives visual input, causing an interruption in their field of vision that can be annoying, disturbing, and possibly debilitating.

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