DonDraper

To clarify one thing Visual mentioned - it's actually both benzos and alcohol that are potentially lethal if withdrawn too quickly. Both act on the brain's calming neurotransmitter, GABA, which means that sudden withdrawal can cause hyperexcitability of the central nervous system. Indeed, benzos and alcohol are so similar in their effect on GABA than benzos are sometimes prescribed to alcoholics to assist with their taper. Do not go cold turkey from benzos if you've been using them for a extended period of time. Probably best to taper under the supervision of a doctor, but the following is a very good guide: www.benzo.org.uk/manual

I think Vyvanse risks making it permanently worse. I don't think you can say for sure, because everyone seems to be different in how they respond to meds, but I don't think it's a risk worth taking, at least without Keppra. Actually, I'd stick clear of stimulants altogether - there are other meds you can try for ADD that are non-stimulants. I take imipramine, a tricyclic antidepressant, which has been really useful and seems to have also made the HPPD slightly better. You can also take atomoxetine, bupropion, venlafaxine, guanfacine or clonidine. Downside of these meds is that they work in fewer people than stimulants, but you've still got a more than 50% chance with each medication. Clonidine has been used to treat HPPD before, so could be a good place to start if you have hyperactive or combined type ADD (it's not so effective for inattentives). Does your psych know about your HPPD?

There is a good guide for tapering from benzos called the Ashton Manual. Google it and it should come up. Gives a very detailed explanation of the process (it was written for both physicians and patients) and tapering schedules for the different benzos. You may need to switch from clonazepam to a less potent benzo, like diazepam, to allow for a smooth taper from a dose as low as 0.5mg (0.5mg of clonazepam = 10mg of diazepam). Always discuss with your doctor first, tho.

I take it for ADHD - can't take stimulants for obvious reasons! Was actually going to try desipramine myself, but I can't get it in my country. I take a very low dose of imipramine and the only effects seem to be that I feel calmer and more focussed. No improvement in mood, but then I'm taking less than a fifth of the usual dose for depression. I remember reading on a visual snow forum that some people found TCAs made their symptoms worse to begin with, much as bupropion seems to make HPPD visuals worse for the first couple of weeks. I haven't found this to be the case, personally, though. Out of interest, do you see a psych, a neurologist or a PCP? What's their take on HPPD?

Yep, I take imipramine. Only impact on my visual snow seems to be that it's smoother, which I think is a positive. Interestingly, tricyclics are also prescribed for persistent migraine aura without infarction, which sometimes produces HPPD-like symptoms. I have read of amitryptiline being prescribed and successfully treating the visual symptoms of persistent migraine aura, including visual snow. Anecdotally, I've also heard that some doctors prescribe it for HPPD but I'm not aware of any published evidence for its efficacy in our condition. The best tricyclics for migraines are amitryptline and nortryptiline. Nortrip has fewer side-effects. The nice thing about tricyclics is that you can start on a very low dose, as low as 10mg, and work your way up to a maximum dose of 100-200mg (depending on the specific drug). That way you can take things slow and hopefully minimise side-effects. Some people find that even only 10mg is enough to provide symptom relief (depending on what they are taking it for - the therapeutic window varies by condition). The downside is that there is a reason why, despite their excellent efficacy in treating a number of conditions, they are only infrequently prescribed these days: the side-effects at medium to high doses can be severe, and many people discontinue taking the meds as a result.

Have done some more reading on other forums, it seems that amitriptyline has been successfully used in the treatment of HPPD. The OP's doctor reports using it for a number of HPPD patients, although the OP is not herself an HPPD-er. Here is part of the discussion: OP: "For the first 3 weeks i took this drug at 10mg at night, for the following 3 weeks to present ive been taking 20mg at night. I can tell my VS is improving, as well as the tinnitus is 99% gone. i dont even notice it anymore. The good news about this drug is it is effective even at this very low dose, you wont see results for about 4-5 weeks but then ul see improvement." OP: "The doc who gave it to me said he's seen a lot of vs people. He uses it a lot on hppd people too."

Dr Henry Abraham and Dr John Halpern have published academic articles on HPPD and are both based in Boston. Dr John Ratey is a neuropsychiatrist who has worked with perceptual disorders, though I don't know if he has treated HPPD before. Dr A is on the faculty at Tufts and the other two are at Harvard, so they're all near the top of their profession.

Would be curious to know how others have treated ADD without exacerbating HPPD. Currently trying to figure out a way of doing this myself... 415_STYLEE - are you still taking methylphenidate?

Has anyone tried any of the tricyclics (amitriptyline, desipramine etc)? I read on a VS forum that amitriptyline is sometimes prescribed for VS in persistent migraine aura, but I'm cautious about assuming that it will work for HPPD on this basis alone...

Cool, thanks for the advice. Dealing with the light sensitivity would be good, if only because it would be nice to not look like a pretentious douche for wearing sunglasses indoors ;-)

Visual symptoms are VS, photophobia and some slight afterimaging. The VS isn't too intense but the flicker rate is quite high. Combined with the photophobia, it can cause eye strain and headaches. When this all started, lights would sometimes flicker, images on the TV would pixellate when the camera moved, and there was some bleeding of colours. These symptoms subsided fairly quickly, though. As far as the psychological symptoms go, I've thankfully avoided DP/DR, but have occasional bouts of anxiety (I've always had a slightly anxious disposition). So far I've avoided trying Keppra or Lamictal as the side-effects look worse than those of the other meds. Wouldn't rule them out, though.

Thanks. I've tried guanfacine (2mg/day) and diazepam (1-2mg, as and when needed). I had read that some people were successfully treated with clonidine, so thought that guanfacine, which is also an alpha-2 agnoist, might be a good bet. Unfortunately, the guanfacine didn't do anything apart from make me lethargic. Diazepam can be helpful and the positve effects on visual snow seem to last longer than the half-life of the drug, though the snow returns "to baseline" after a few days. I've not tried using diazepam continiuously for any significant period, as I want to avoid becoming dependent. Interestingly, guanfacine seemed to enhance the effect of diazepam on the visual snow, but I found the two together were incredibly sedating and the online interactions checker said to use them together with caution. Was the amantadine any good for the visuals or did you take it for the psychological symptoms?

How did the amantadine work out? Am considering it, but there are hardly any reports from those who've taken it...