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Study suggests that taking Clonazepan for 2 months can resolve symptoms


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Yeah I know, hard to believe, but it's a proper scientific paper. Their suggested treatment was 2mg /daily for 6 months.

Has anyone here tried this protocol?

 

Benzodiazepines are one of the recommended agents for the treatment of HPPD but it is unclear which of them may be more helpful. The goal of our investigation was to assess the efficacy of clonazepan in the treatment of LSD-induced HPPD. Sixteen patients fulfilled entrance criteria. All complained of HPPD with anxiety features for at least 3 months and were drug free at least 3 months. They received clonazepan 2 mg/day for 2 months. Follow-up was continued for 6 months. They were weekly evaluated during the 2 months of clonazepan administration and monthly during the follow-up period using the Clinical Global Impression Scale, a Self-report Scale and Hamilton Anxiety Rating Scale. Patients reported a significant relief and the presence of only mild symptomatology during the clonazepan administration. This improvement was clearly sustained and persisted during a 6-month follow-up period.

Src: https://journals.lww.com/intclinpsychopharm/Abstract/2003/03000/Clonazepam_treatment_of_lysergic_acid.7.aspx

lerner2003.pdf

Edited by rlopes
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Correct me if I'm wrong, but that sounds like the participants took the clonazepan for 2 months, not 6. Can anyone clarify if this means that they stopped taking the clonazepan and they continued to maintain the improvement seen while taken the medication?

Edited by neffbull
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So I did some digging around to try and find more information on this study. Unfortunately, it's locked behind paywalls so I requested access from the author and hopefully they will come through. It is mentioned in another paper though that sheds a little bit more light on the study.

"Clonazepam has been evaluated in three case reports and one open-label trial by Lerner [19,50,51]. In the clinical trial, 16 HPPD patients were treated with a Clonazepam dosage of 2 mg/day [51]. Their symptoms improved significantly after treatment initiation and the improvement persisted during a 6-month follow-up after treatment discontinuation [51]. The same author reported two cases of cannabis-induced visual disturbances and correlated anxiety features. In both cases, Clonazepam (2 mg/day) was effective in improving symptoms, but focal visual disturbances without anxiety (trailing phenomena in one case, and black moving spots in the second case) persisted during and after therapy [19]. More recently, Clonazepam (6 mg/day) has been proved to be effective in improving cannabis-induced HPPD symptoms [50]. On the other hand, the intrinsic abuse potential of benzodiazepines might be inconvenient in certain individuals with a past history of substance use [17,18]. Given the benign nature of HPPD I, the use of benzodiazepines should be proposed only for severe cases, in the acute phase, and for the short term."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870365/

 

Hallucinogen Persisting Perception Disorder Etiology, Clinical Features, and Therapeutic Perspectives.pdf

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Found a case report that states a person had it for 25 years and was mostly symptom free 3 months after being prescribed Clonazepam 1 mg four times. 8 of the 9 listed symptoms were absent and the one that was still present, Halos around objects, was reduced in intensity and frequency.

" A forty-eight year old man presented with unusual and distressing visual experiences with varying degrees of severity for over twenty years. Some of these included the following; red objects having a green shimmer around them like 3-D glasses, altered sense for distance estimation, people’s faces seeming to change shape when looked at, alteration of own reflection, anything patterned appearing to move all the time, words moving about while reading, things appearing to be multi-layered, bright lights throwing up shadows, vehicles appearing to stretch as they drive past, flying birds looking like animation and difficulty in focusing.

When present, his symptoms interfered markedly with his functioning. For example, he could not cross the road, could not read, and had to dim his lights. He struggled with knowing which visual perceptions were real and which were not. The patient felt his visual experiences were related to his past LSD use twenty-five years ago. He felt the drug had put him “in a coma” and he was “dreaming all of this”. "

 

"His other complaint was that of feeling he was “not real”; to the extent he even thought he should harm his family members so he could prove he was real.

He also complained of low mood, decreased concentration, anxiety and an inability to cope.

His first contact with mental health services was at the age twenty two years. He presented with symptoms of anxiety but it was not felt he had a mental illness. He was referred again a year later and was diagnosed to have Primary Depersonalization syndrome.

The patient himself reported that all his symptoms started after he had used LSD about fifteen times in six months. At the time he had described having undergone a complete personality change due to his experiences. He felt objects and experiences had a dream-like quality. His visual experiences caused so much distress he felt suicidal."

 

"Investigations: EEG, MRI Brain, and Carotid ultrasound were normal."

 

"He was admitted to a psychiatric hospital at the age of forty-eight years old where the admitting doctor described his symptoms as visual hallucinations and started him on Risperidone, which increased the intensity of his symptoms. He was also treated with Citalopram for his low mood. It was noted that his symptoms were different from common psychotic illnesses. Detailed history taking and assessment of his perceptual abnormalities over the following few weeks in hospital confirmed the diagnosis of hallucinogen persisting perception disorder (HPPD).

He was treated with Clonazepam 1 mg four times a day with good effect; as seen by the reduction of symptoms"

 

"There have been some published case reports on treatment of HPPD, including the use of Reboxetine, which suggest it is beneficial in the treatment of the visual disturbances and depressive features associated with HPPD. This is possibly due to its alpha 2 adrenoceptor modulating effect on both Noradrenaline and Serotonin release8. Another case report suggested the use of a combination of Fluoxetine and Olanzapine in the treatment of HPPD9."

https://www.bjmp.org/content/25-years-hallucinogen-persisting-perception-disorder-diagnostic-challenge

 

25 years of Hallucinogen Persisting Perception Disorder- A diagnostic challenge.pdf

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This paper includes a couple more cases where clonazepam helped as well as a few more cases where other medications either helped or potentially made symptoms worse.

"An observational study recruited 21 HPPD subjects who were treated with benzodiazepines and/or phenothiazines (3). Among subjects receiving benzodiazepines, eight out of nine reported a reduction in intensity/frequency of visual disorders. Most (11 out of 12) phenothiazine-treated subjects described an exacerbation of HPPD (3)."

"A study described two HPPD outpatients who efficaciously responded to clonazepam (25)."

"An open-label study recruited 16 drug-free patients affected with HPPD with anxiety features for at least 3 months who received 2 mg daily of clonazepam for 2 months (27). Subjects reported a significant relief of anxiety and HPPD symptomatology with only mild symptomatology during the clonazepam treatment, suggesting the efficacy of clonazepam in these cases (27)"

https://www.researchgate.net/publication/321166980_The_Endless_Trip_among_the_NPS_Users_Psychopathology_and_Psychopharmacology_in_the_Hallucinogen-Persisting_Perception_Disorder_A_Systematic_Review/fulltext/5a12d25c4585158aa3e1bb29/The-Endless-Trip-among-the-NPS-Users-Psychopathology-and-Psychopharmacology-in-the-Hallucinogen-Persisting-Perception-Disorder-A-Systematic-Review.pdf#page=1&zoom=auto,-406,786

https://www.frontiersin.org/articles/10.3389/fpsyt.2017.00240/full

The “Endless Trip” among the NPS Users Psychopathology and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review.pdf

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The study that includes the two HPPD outpatients mentioned above isn't readily accessible online. I found the abstract and introduction though.

"Benzodiazepines are recommended for the treatment of Hallucinogen Persisting Perception Disorder (HPPD), although it is unclear which may be more helpful. Two out-patients with LSD-induced HPPD were successfully treated with clonazepam. They had not responded to low potency benzodiazepines or low doses of classic antipsychotics. After clonazepam discontinuation they reported a marked improvement and only mild symptomatology which persisted during a six month follow-up period. High potency benzodiazepines like clonazepam, which has serotonergic properties, may be superior to low-potency benzodiazepines in the treatment of some patients with LSD-induced HPPD."

https://search.proquest.com/openview/fc6d8758115dc39152bc59ddaf587dc6/1?pq-origsite=gscholar&cbl=47717

LSD-induced hallucinogen persisting perception disorder treated with clonazepam Two case reports.pdf

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This is case report shows clonazepam helping two people who developed HPPD from Synthetic Cannabis.

 

Synthetic Cannabis Substances (SPS) Use and Hallucinogen Persisting Perception Disorder (HPPD): Two Case Reports

"On psychiatric examination the patient reported visual occurrences which were similar to those experienced during SCS use and resembled intoxication-associated visual imagery. These almost daily episodes usually lasted between fractions of a second and a few minutes. The perceptual disturbances were sufficiently severe to cause significant distress, anxiety and impairment in social and occupational functioning. Mr. R fulfilled DSM-IV-TR diagnostic full criteria of HPPD (3). There was no previ-ous neurological, ophthalmological or other comorbid medical diseases or co-occurring psychiatric history. A complete physical, neurological (including EEG), and laboratory examination was unremarkable. Uncomplicated outpatient SCS withdrawal was unexpect-edly mild and was treated with small doses of clonazepam (5-8). Dosage started at 0.25 mg bid gradually increased to 1 mg bid after two weeks...

His condition dramatically started to improve. He continued taking clonazepam 1mg bid for the next five weeks. After completing two months of treatment, he refused to continue pharmacological treatment stating that he does not need more “chemicals in his body.” He agreed to gradually stop clonazepam. After treatment suspension he continued to report considerable improvement in the frequency of perceptual disturbances and accompanying anxiety. At his six-month evaluation he reported that symptoms had disappeared almost completely. Despite the prominent amelioration, Mr. R continued to complain of focal visual disturbance known as trailing phenomena that remained without accompanying anxiety features."

 

"On psychiatric evaluation Mr. B accurately recog-nized SCS as the precipitator of his condition (5-8). He reported that the panic attack was so distressing that SCS ingestion was immediately ceased. Disturbances were sufficiently severe to cause significant distress, anxiety and impairment in social and occupational functioning. He fulfilled DSM-IV-TR full criteria of HPPD (3). As in the case of R described above, all examinations revealed no abnormalities Uncomplicated outpatient SCS withdrawal was described as mild and treated with low doses of clonaz-epam, in a regimen described in the previous case. Mild anxiety features and sleep disturbances accompanied the withdrawal process. The patient was reluctant to be treated with “chemical drugs” (i.e., medications) and only accepted to take medication for a period of one month. He preferred to cope with his condition without medications, psychotherapy or counseling. Mr. B’s episodes of HPPD gradually became more benign and less distressing. His condition dramatically started to improve. After clonazepam suspension he continued to communicate a clear improvement in the frequency of perceptual disturbances. During the fol-lowing three months symptoms disappeared almost completely. At the end of six months an almost total absence of visual disturbances was reported. Despite the profound reported improvement, he continued to suffer from benign non-distressing perceptual disturbances characterized by black moving spots in his visual fields.DIscUssIONThough HPPD has been well-described and reviewed in the literature following use of various hallucinogenic substances (9), little is known about these phenomena following use of new “designer drugs.” Above we described two cases of HPPD following SCS use. While the exact subjacent mechanism of SCS associ-ated perceptual disturbances is largely unknown, there is some knowledge indicating similarities with those proposed mechanisms associated with the use of LSD (6) and NCS(1)."

https://cdn.doctorsonly.co.il/2015/01/09_Synthetic-Cannabis.pdf

https://www.researchgate.net/publication/281847744_Synthetic_Cannabis_Substances_SPS_Use_and_Hallucinogen_Persisting_Perception_Disorder_HPPD_Two_Case_Reports

 

Synthetic Cannabis Substances (SPS) Use and Hallucinogen Persisting Perception Disorder (HPPD) Two Case Reports.pdf

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On 5/9/2021 at 2:59 PM, neffbull said:

Correct me if I'm wrong, but that sounds like the participants took the clonazepan for 2 months, not 6. Can anyone clarify if this means that they stopped taking the clonazepan and they continued to maintain the improvement seen while taken the medication?

Yes, that's exactly what it means. They took it for 2 months and the improvements persisted! That's why I am so impressed.

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23 hours ago, neffbull said:

So I did some digging around to try and find more information on this study. Unfortunately, it's locked behind paywalls so I requested access from the author and hopefully they will come through. It is mentioned in another paper though that sheds a little bit more light on the study.

I just attached the full article in the first post. I hope it helps.

Thank you for posting you research as well.

I am doing a Lamotrigine protocol now. If it doesn't work I might try this Clonazepan protocol aftwards.

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2 months would put you at risk of addiction/withdrawal, so be careful.

My view on this is that it could help in the early stages... Where the stress and anxiety of hppd creates a loop that makes hppd worse... Treating the stress and anxiety with clono might help the user break that loop and recover quicker. Not sure why it would help long term sufferers though, personally (as a cure rather than a band-aid).

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Posted (edited)
3 hours ago, Jay1 said:

2 months would put you at risk of addiction/withdrawal, so be careful.

My view on this is that it could help in the early stages... Where the stress and anxiety of hppd creates a loop that makes hppd worse... Treating the stress and anxiety with clono might help the user break that loop and recover quicker. Not sure why it would help long term sufferers though, personally (as a cure rather than a band-aid).

I also thought it would just be a band-aid before reading these articles, but they seem to indicate they can bring a permanent cure, if taking at a specific protocol, and some of them are using participants who've had HPPD for longer than 10 years.

Edited by rlopes
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On 5/10/2021 at 2:17 PM, rlopes said:

I just attached the full article in the first post. I hope it helps.

Thank you for posting you research as well.

I am doing a Lamotrigine protocol now. If it doesn't work I might try this Clonazepan protocol aftwards.

Appreciated and downloaded. This all looks really promising. I've taken Lamictal in the past and it definitely helps with minimal side effects.

12 hours ago, Jay1 said:

2 months would put you at risk of addiction/withdrawal, so be careful.

My view on this is that it could help in the early stages... Where the stress and anxiety of hppd creates a loop that makes hppd worse... Treating the stress and anxiety with clono might help the user break that loop and recover quicker. Not sure why it would help long term sufferers though, personally (as a cure rather than a band-aid).

All of these studies and case reports seem to report otherwise. Whatever is the cause of HPPD, Klonopin appears to at the very least alleviate some of the symptoms permanently which is a god send. I've heard for a while that it possibly a seizure disorder and klonopin can help in that regard ( I believe this is discussed in one of the above studies ) so there is a possible link there.

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I found it mentioned in the article that rlopes posted. Included is why they thought the medication was helpful.

"There is some evidence that anticonvulsive agents such as phenytoin, carbamazepine and valproic acid (Thurlow and Girvin, 1971; Abraham, 2000) may ameliorate this psychopathology, which may be interpreted as a ‘visual seizure’ (Thurlow and Girvin, 1971). Such an approach may help to explain the efficacy of benzodiazepines. Benzodiazepines seem to be the treatment of choice for the majority of patients (Abraham, 1983). They may improve, but not totally remove, this condition (Abraham et al., 1996). Among the wide range of available benzodiazepines, it is still unclear which of them may be more effective (Lerner et al., 2001)."

Mind that Lerner said this a year before doing this study.

 

"The effectiveness of benzodiazepine may be related to benzodiazepine activity at cortical serotonergic inhibitory interneurons with GABAergic outputs (Abraham and Aldridge, 1993; Abraham et al., 1996). Additional benefits regarding clonazepam may be proposed. There is a substantial amount of literature suggesting that clonazepam may affect serotonergic systems and that it may enhance serotonergic transmission (Bodkin and White, 1989; Hewlett et al., 1992). This may secondarily lead to down regulation of 5-HT2 receptors, which may contribute to the HPPD symptoms remission (Young, 1997). The specific serotonergic characteristics of clonazepam, along with its high potency, rapid rate of absorption and long lasting action, may play an important, although unclear role, in the observed improvement of the reported patients"

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There has been 20+ years of research and experimentation since then, I think it's pretty telling that Dr Abraham himself doesn't/didn't seem to use this "2 month clonazepam" treatment for any of the people on this forum who were diagnosed by him (please correct me if I am wrong).

Benzos are amazing if used correctly, but i'm just asking people to tread cautiously here and get medical advice. 

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I just recently talked to a guy that got HPPD with a loads of visual hallucinations, visual snow, dpdr etc about 10 years ago. He thought that he had destroyed his brain permanently, so he said "fuck it" and started using benzos and alcohol at a daily basis. Anyways, after a few years all his visual hallucinations went away and today his visual snow has decreased alot, he said that his HPPD is 95% gone. He did stop with the benzos and alcohol about 4 years ago and these improvements remained, his dpdr is still there though. The benzo withdrawals were so bad that he had to put himself in though.

Edited by Hall89
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I'll look around more when I have a moment but this is what showed up when I searched Dr. Abraham HPPD klonopin.

"According to Abraham about half of those with HPPD will fully recover over five years. In addition, treating the comorbidities can actually help alleviate the core HPPD symptoms, since anxiety and depression appear to trigger the hallucinations. Benzodiazepines “can be helpful by reducing anxiety, which then decreases reactivity to environmental stimuli,” he noted. Clonazepam seems to be the most effective.6"

https://www.neurologylive.com/view/when-partys-over-case-hppd

Unfortunately HPPD is fairly rare disorder that most doctors aren't trained to treat so having studies to provide them with can only benefit the people on here. Also it gives some much needed hope.

 

What did Dr. Abraham normally prescribe?

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11 hours ago, neffbull said:

According to Abraham about half of those with HPPD will fully recover over five years. 

I wonder how accurate this is and what he means with recovery. Is it symptoms actually going away or people recovering mentally? I hate him for not being more specific.

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This is from a visual snow forum.

"Sara took Klonopin for about 6 weeks in hopes of improving her visual

disturbances. This was prescribed after we and her doctor had a phone

consultation with Dr. Henry Abraham, the HPPD expert. He said about 50% of

his patients visual disturbances disappeared after treatment with

long-acting benzodiazepines like Klonopin or Valium"

https://www.tapatalk.com/groups/thosewithvisualsnow/hppd-vs-visual-snow-validation-of-vs-t2332.html

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So I have a theory on hppd that involves hyperactivity (of dysregulation) of mtorc1 and mtorc2. One of the things that happens in this scenario, is gaba a receptors... well the easiest way to describe it is they go bad hide. This is part of a cyclic loop that causes this brain state that is excitatory and cannot heal itself. 
 

I think there is some merit to the idea that a high dose of benzodiazepine for a short period may help. But it seems that it’s important it be clonazepam. Clonazepam is a pretty unique benzo. It also acts on serotonin systems seemingly without causing panic in people with hppd which is unusual. And 
 

I do think if you were to take 6mg daily for 2 months straight and cold Turkey you may experience withdrawals. And not only that, cold Turkeying benzos is bad for the shape of the receptor. 
 

I do not see a lot of harm in trying this. A short taper would be all that is needed after use. 
 

that being said, if the experiment fails, it is harder for our brains, imo, to get off benzos as we are in such a hyper excitable state. 
 

still, other experiments with hppd are much riskier. Like the microdose fire with fire method... yikes. 
 

 

see this is interesting: https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00844/full

 

ketamine induced rapid antidepressant effects by up regulating mtorc1 (as does lsd). When I see things that dampen that effect, I see potential. Naltrexone is another drug I find effective (if you can get over the short dysphoria event) and also inhibits mtorc1.

 

Anecdotally, I heard a guy doing this and it working. But it’s a vague memory and I’m not sure where to find the post. 
 

I have a rem sleep disorder that the only medication to treat it is clonazepam. I may give this a shot haha. 

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On 5/13/2021 at 4:51 AM, Jay1 said:

There has been 20+ years of research and experimentation since then, I think it's pretty telling that Dr Abraham himself doesn't/didn't seem to use this "2 month clonazepam" treatment for any of the people on this forum who were diagnosed by him (please correct me if I am wrong).

Benzos are amazing if used correctly, but i'm just asking people to tread cautiously here and get medical advice. 

IMO the main reason not to use Clonazepam is the high risk for dependence after 2 months at 2mg daily.

It's likely the treatment works, but the risk is significant.

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On 5/15/2021 at 9:06 AM, Hall89 said:

I wonder how accurate this is and what he means with recovery. Is it symptoms actually going away or people recovering mentally? I hate him for not being more specific.

Hey man. I've seen your posts on Reddit, and that you think visual recovery is impossible. Please note that there are indeed scientific studies that use Visual Scales to measure this, and they show that improvement in this regard is possible. I can make another thread to post this later.

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8 hours ago, Onemorestep said:

So I have a theory on hppd that involves hyperactivity (of dysregulation) of mtorc1 and mtorc2. One of the things that happens in this scenario, is gaba a receptors... well the easiest way to describe it is they go bad hide. This is part of a cyclic loop that causes this brain state that is excitatory and cannot heal itself. 
 

I think there is some merit to the idea that a high dose of benzodiazepine for a short period may help. But it seems that it’s important it be clonazepam. Clonazepam is a pretty unique benzo. It also acts on serotonin systems seemingly without causing panic in people with hppd which is unusual. And 
 

I do think if you were to take 6mg daily for 2 months straight and cold Turkey you may experience withdrawals. And not only that, cold Turkeying benzos is bad for the shape of the receptor. 
 

I do not see a lot of harm in trying this. A short taper would be all that is needed after use. 
 

that being said, if the experiment fails, it is harder for our brains, imo, to get off benzos as we are in such a hyper excitable state. 
 

still, other experiments with hppd are much riskier. Like the microdose fire with fire method... yikes. 
 

 

see this is interesting: https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00844/full

 

ketamine induced rapid antidepressant effects by up regulating mtorc1 (as does lsd). When I see things that dampen that effect, I see potential. Naltrexone is another drug I find effective (if you can get over the short dysphoria event) and also inhibits mtorc1.

 

Anecdotally, I heard a guy doing this and it working. But it’s a vague memory and I’m not sure where to find the post. 
 

I have a rem sleep disorder that the only medication to treat it is clonazepam. I may give this a shot haha. 

Yes, just be really careful. I will first try the Lamotrigine 200mg during a year to see if that resolves the issue. I think the risk/reward is better. The 2mo Clonazepam is riskier and should be considered an alernative treatment IMO.

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22 hours ago, rlopes said:

Hey man. I've seen your posts on Reddit, and that you think visual recovery is impossible. Please note that there are indeed scientific studies that use Visual Scales to measure this, and they show that improvement in this regard is possible. I can make another thread to post this later.

Studies actually proving that HPPD visuals, like vs, can go away? If so, pleasr share.

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1 hour ago, Hall89 said:

Studies actually proving that HPPD visuals, like vs, can go away? If so, pleasr share.

Proving reductions of more than 50% in symptoms. I think I've seen some showing cases of 100% remission. I'll make a list as soon as get some time.

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Absolutely. As someone who has been through benzo withdrawal and never felt quite the same I would say caution is important haha. I also worry that the withdrawn brain is more primed for withdrawals in the future via kindling. This has been my experience at least. 
 

Still, it’s a tempting offer isn’t it. Take 6mg of klonopin a day for 2 months and reduce your hppd?...

 

...can I do it on a beach too somewhere 😂?

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