From the Guidelines
Quetiapine is not a standard treatment for Hallucinogen Persisting Perception Disorder (HPPD) and its use should be approached with caution due to potential variable effects on individuals, including the risk of inducing panic attacks. The evidence for quetiapine's effectiveness in HPPD is largely anecdotal and based on case reports, with no high-quality studies to support its use as a first-line treatment 1. Regarding panic attacks, quetiapine can have a dual effect, potentially alleviating anxiety in some cases while exacerbating it in others, particularly during the initial treatment phase or with dose adjustments. This dual effect is attributed to quetiapine's impact on multiple neurotransmitter systems, including serotonin, dopamine, and norepinephrine, which play roles in both perception and anxiety regulation.
Given the lack of strong evidence and the potential for adverse effects, if quetiapine is considered for managing HPPD symptoms, it should be used under close medical supervision. The recommended approach is to start with a low dose, typically 25-50mg, and gradually increase as needed while closely monitoring for adverse effects such as increased anxiety, sedation, metabolic changes, or movement disorders 1. It's also important to consider the patient's overall clinical context, including any history of substance use, psychiatric comorbidities, and previous responses to pharmacological treatments.
In the context of palliative care, quetiapine has been considered for the management of refractory insomnia and delirium, suggesting its potential utility in specific clinical scenarios beyond HPPD 1. However, these uses are also guided by the principle of careful patient selection and monitoring due to the drug's side-effect profile. Ultimately, the decision to use quetiapine for HPPD or any other condition should be made on a case-by-case basis, weighing the potential benefits against the risks and considering alternative treatment options that may offer a more favorable risk-benefit profile.
From the Research
Efficacy of Quetiapine for HPPD
- There are no research papers to assist in answering this question regarding the efficacy of quetiapine for Hallucinogen Persisting Perception Disorder (HPPD) 2, 3, 4, 5, 6.
Induction of Panic Attacks by Quetiapine
- The provided studies do not mention the induction of panic attacks by quetiapine as a common side effect 2, 3, 4, 5, 6.
- Quetiapine has been shown to be effective in treating anxiety symptoms in patients with depressive or anxiety disorders, with statistically and clinically significant reductions in anxiety symptoms 4.
- The most frequent side effects reported in the studies were mild dry mouth, constipation, and transient drowsiness with dose escalation, but panic attacks were not mentioned 4, 5.