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StateOfRegret

A Gordian knot: anxiety medication & HPPD

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Hey all!
 
I'm still searching for a medication to treat my anxiety problems that won't simultaneously aggravate my HPPD. As many of you know, that is one tough nut to crack. My immediate thoughts:

  • SSRIs: Seem somewhat effective for my anxiety. Aggravates visuals, had to discontinue. At least HPPD symptoms returned to ''baseline'' upon discontinuation.
  • Benzodiazepines: Greatly attenuates my anxiety (particularly etizolam and clonazepam) and helps HPPD symptoms as well (particularly clonazepam). Very addictive, not a long term solution. I build tolerance to benzodiazepines pretty quickly.
  • Buspirone: Seems too ineffective to be worth it (never actually tried this one)
  • Pregabalin/gabapentin: Seem to have many of the same pitfalls as benzos, plus some extra common side effects(?)
  • Beta blockers: Ineffective in managing my anxiety, since it doesn't primarily manifest with tachycardia, tremors, flushing etc.
  • Atypical antipsychotics: Seems like a dangerous combo w/HPPD (particularly risperidone).
  • Older/atypical antidepressants, such as TCAs: Never tried any of those. Very interested in hearing personal experiences or ideas about any non-SSRI antidepressants useful in treating anxiety, particularly about how they interact with HPPD.

Thanks in advance, folks :)  Hope you're feeling all right. Looking forward to hear any and all thought on possible anxiety medications w/HPPD.

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check out my post about ashwagandha extract, shit really works. and when you feel like you have bad anxiety have a caffeine free soda, its always helped me as sugar releases a load of natural opiotes and as with eating in general releases dopamine

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Thanks for your well meaning post.
With all due respect, "if you have real bad anxiety, drink a soda" is the sort of thing someone who doesn't know bad anxiety would say.
I'm looking for experiences with anxiety medication and HPPD. :-)

 

Edit: As for Ashwagandha; I don't feel like going into these herbal supplements in this thread, but suffice to say, ashwagandha is a GABA agonist. One might as well use a well-researched benzodiazepine if looking for GABA agonism (or positive allosteric modulation, but I digress...).

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sorry i see what you mean, its always helped for me though cause im addicted to sugar and caffeine so it does the opposite of what you'd expect it would and completely mellows me out. propanolol is used for high blood pressure,it didnt do to much for my anxiety but ive heard many others say it helped, look it up

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Benzos and alcohol have been the only things that work for me, so far. None of the other meds did anything significant, even barbiturates.

 

Now that I have fully accepted this shit is with me for life... I've tailored a bit of a masterplan for my anxiety

 

Thursday evening - 3-4 light beers

Friday morning - 1mg Klono - 3-4 light beers in the evening

Saturday morning - 1 mg Klono - a few beers or glasses of wine in the evening.

Sunday morning - 1.5mg klono.

 

Sunday's klono has some effects on a Monday... So I really only have Tuesday and Wednesday without any kind of anxiety dampening. Hitting the gym hard those days helps.

 

Now, that is not a system for everyone... Just what works for me. Benzos and alcohol is not wise, for starters..... I seem to be fine with the combo, for the most part (probably as I have 12 hours between the klono and alcohol... then keep it to just a few drinks).... But it can be deadly.

 

The alcohol gives me back a bit of a social life though.... I find even just a couple of beers is enough to bring me out of my shell and have a bit of fun and laughs... To me, that is everything. I feel like I have a life again and that is all down to those beautiful benzos, as even 2 beers would send me into an anxious mess the next day, without them.

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Thanks for sharing, Jay! :-)
I don't particularly enjoy alcohol these days, but using benzos ''sparingly'' has also been the only solution that gives me a feeling of being able to handle life and my anxiety. Gotta go, just wanted to thank you for sharing your ''masterplan'' :D

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My weekly pattern is somewhat the same as Jay´s, except my ongoing Lamictal trial which only seems to reduces DP/DR and mood swings. But yeah, a few beers, some wine and a couple of benzos in my system gives me that little spark. Make sure to take a few weeks off once in a while if you´re following this system just to prevent tolerance and addiction. As an alternative to clonazepam, I´d recommend valium or oxazepam. The latter, in my experience at least , doesn´t make you drowsy, lazy and forgetful, although it might not be "strong" enough to combat full on panic attacks. And even though my Sertraline trial reduced depression and anxiety for the time being, it also worsened my visual baseline. Good luck :)

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I got propranolol. Works pretty good but only if used like twice a week. I also used Gabapentin and same applies to that. I'm not on either one anymore but I think if possible it would work best if you could alternate between Gabapentin, Propranolol and a benzo.  Take each like once a week or twice at most. Other than that I found all to pretty much stop working relatively quick other than benzos but they aren't worth taking everyday imo. Have you tried other things like magnesium, taurine, passion flower or anything along those lines?

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And even though my sertraline trial reduced depression and anxiety for the time being, it also worsened my visual baseline. Good luck :)

Right, I remember your thread about that :) .

 

Personally, I'm considering giving mirtazapine a go. Interesting pharmacological profile (5HT2A antagonism, antagonist at some alpha-adrenergic receptors, only very weak dopamine antagonism). One of the ''atypical'' antidepressants in that it doesn't work as a reuptake inhibitor! Psychiatrists often prescribe it together with bupropion, to counter some of the drowsiness, appetite stimulation and so on. I remember reading here that bupropion (Wellbutrin) was generally well recieved by the few HPPD sufferers who had tried it.

From wikipedia:

In contrast to mirtazapine, the SSRIs, SNRIs, MAOIs, and some TCAs increase the general activity of the 5-HT2A, 5-HT2C, and 5-HT3 receptors [...]

5HT2A activity is definitely something to be avoided, so this would be a big plus for mirtazapine in my book, at least on paper.

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You ever hear of an antidepressant called Agomelatine? I works on the melatonin system. I tried getting some from my doctor but IDK wtf he is doing he is being a fucking moron right now. Might be something to look into if you want an antidepressant with anxiolytic properties without being serotonergic. 

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Personally, I'm considering giving mirtazapine a go. Interesting pharmacological profile (5HT2A antagonism, antagonist at some alpha-adrenergic receptors, only very weak dopamine antagonism). One of the ''atypical'' antidepressants in that it doesn't work as a reuptake inhibitor! Psychiatrists often prescribe it together with bupropion, to counter some of the drowsiness, appetite stimulation and so on. I remember reading here that bupropion (Wellbutrin) was generally well recieved by the few HPPD sufferers who had tried it.

From wikipedia:

In contrast to mirtazapine, the SSRIs, SNRIs, MAOIs, and some TCAs increase the general activity of the 5-HT2A, 5-HT2C, and 5-HT3 receptors [...]

5HT2A activity is definitely something to be avoided, so this would be a big plus for mirtazapine in my book, at least on paper.

 

Judging by the wiki article it certainly looks like it might yield more benefits than a SSRI. Let us know if you give it a try!

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Thanks for your well meaning post.

With all due respect, "if you have real bad anxiety, drink a soda" is the sort of thing someone who doesn't know bad anxiety would say.

I'm looking for experiences with anxiety medication and HPPD. :-)

Edit: As for Ashwagandha; I don't feel like going into these herbal supplements in this thread, but suffice to say, ashwagandha is a GABA agonist. One might as well use a well-researched benzodiazepine if looking for GABA agonism (or positive allosteric modulation, but I digress...).

Don't discredit the viability of herbal supplements so vehemently. Acetyl-L-Carnitine is saturated in fish and can assist with memory recall and increased cognitive function, Vinpocetine is an analogous derivative of vincamine, naturally extracted from the periwinkle flower and increases oxygen levels in the cerebral cortex for enhanced mental clarity and acuity, Huperzine A addresses acetylcholine deficiencies which is a crucial neurotransmitter for working memory and focus, and it possesses antioxidant compounds. The dilemma with herbal supplements as opposed to pharmacological medication is they aren't subjected to clinical trials, thus leading to lack of empirical data; the FDA has a propensity for not giving a shit about herbal supplements and their implications which exacerbates inclusive data pertaining to these supplements. Coincidentally, the three herbal supplements I listed have gone through rigorous, placebo-controlled clinical trials, and have proved to inhibit cognitive decline.

Individuals on this forum have reported a myriad of benefits from herbal supplements, nootropics and other non-pharm compounds; pharmaceuticals are palliative in treating HPPD at best. Now to address a medication that can attenuate your anxiety issues, I'd research Lamictal; it has a beautiful pharmacological profile and is being employed off-label to treat HPPD; I'll be asking my psych for a prescription soon, as my tolerance to Klonopin is asinine and I genuinely want to alter my medication regimen. With HPPD, I'm a fanatical advocate of neuroplasticity, nutrition and copious amounts of exercise for neural regeneration and cumulative neuronal density increase within the brain. I wish you nothing but luck in finding a suitable med to eradicate your anxiety.

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Don't discredit the viability of herbal supplements so vehemently.

I don't know that I did. I would never claim that supplements, herbal or otherwise, are of no use :) I just said that I meant to discuss pharmaceuticals in this particular topic.

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I've taken Mirtazapine on and off for about 2 years after reading a post on here that read something like "Completely healed from a case of Diagnosed HPPD."  Mirtazapine hasn't affected my visual symptoms positively or negatively.  It helps me sleep and with depression.  It does nothing for anxiety.

 

I'm not sure any non-benzo medications will help you with anxiety.  Especially if you have used a benzo and can compare it to that.  Just my two cents. 

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I understand that you believe your anxiety needs neurochemical relief, and I do not suggest otherwise, but, have you tried any psychotherapy? Cognitive behavioural therapy would be the most appropriate for anxiety. It has shown to be very effective in managing anxiety disorders. This approach requires much more patience and practice, but if you can avoid medication, that would be great, wouldn't it? If anything it will help, and you should do it even if you go on meds. It has helped me lots, but my anxiety is not severe. Practicing mindfulness meditation (taught in CBT) daily rewires your brain not to respond to undesirable thought processes. If you can manage to do a couple of hours a day (1 hr morning, 1 hr evening) I am sure you will manage your anxiety much more effectively.

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Personally, benzodiazepine use on a PRN basis has not worked for me. I've had a lot of problems with clonazepam abuse. If it's there and I'm anxious, depressed or even just bored I will take some. A lot. It takes discipline that I don't have. Probably for the same reason CBT hasn't been effective for me either. It was helpful in the short-term but it's easy to fall back into old habits. But for the stronger willed a combination of the two could work wonders.

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Chris: Yep, certainly takes discipline. Oh, and good to see you posting again :) .

 

I tried a single dose (15mg) of mirtazapine yesterday night. I'm not going to make any statements wrt effectiveness yet, just wanted to say that so far, it hasn't affected my HPPD as far as I can tell. It did make me extremely tired, though. I slept well but awoke feeling exhausted and felt  'zombiefied' for hours. Upon returning from university I fell asleep again and awoke late in the evening. One of the possible side-effects is strange dreams. I had some pretty strange ones while napping, but then again, that's not too unusual for me.

I think I'll postpone giving it a real try for another week, until I have some more time on my hands.

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I'd really recommend afobaloze and tianeptine for anxiety and depression. Neither are addictive or cause negative effects upon ceasing use. (Unlike benzo's and or/ SSRI's - brian zaps anyone?) Both are available without a prescription and I have been using both. It is not a cure for HPPD but neither has worsened my HPPD or DP symptoms.

 

I tried mirtazapene (Remeron in Australia) and it make my so groggy zombie-like in the morning I decided I couldn't live life like that. It definately helps with sleep though!

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Mirtazapine: I've used it for extended periods before. Strangely enough, it doesn't cause any noteworthy HPPD worsening. Odd regarding it's pharmacological profile..

Anyway when I started it, I took 15 mg doses. Onset is quick, 30 mins to full effect. It makes you so sleepy you can barely stand. Sleep onset is quick and duration of sleep can be long, the first night I slept 12 hours straight.

This is because it's a very strong antihistamine, it also antagonizes 5HTA and B receptors, and agonizes 5HTC. It also antagonizes the adrenergic receptors.

So it's sedative and calming, tells your brain to pull the handbrake on wakefulness really!

But, tolerance to the sedative effect is reached within 10 days (according to medical data), and it can't put you to sleep no more.

I had my dose raised to 30 mg, the sedative effect came back for like 5 days.

Then I began to experience symptoms of serotonin poisoning, tremors and dissociation went out of hand. Then I had a clonic seizure (first one ever), and I stopped taking it immidately. Besides, I gained much weight very fast, due to water swelling of tissues which in turn increases fat storage. And I got so damn zombified and lost all passion for life, had much suicidal thoughts in end. Mirtazapine is anxiolytic, but made me worse in the psyche as a whole. And gave me a seizure and made me fat also (weight back to before now though)..

I was prescribed it in a period of benzo withdrawal, no medicine could calm me or make me sleep. My heart rate was up to 150 bpm, blood pressure 150/90.

After the period of Mirtazapine use, it was down at 80 bpm, blood pressure 120/70.

So it saved my life, but also almost took my life, at the same time..

I would say if you use Mirtazapine, take only 15 mg at need, not regularly, with several days spacing in between. Like if you had a long period of terrible sleep, and just need atleast one night of good sleep, take a 15 mg and you'll sleep like the dead!

How Mirtazapine could be classed as an "antidepressant" is a mystery to me. "Prodepressant" is more fitting!!

Agomelatine (Valdoxan):

It's a specific melatonin and 5HTC reuptake inhibitor. Basically, quite similar effect to pure melatonin but with longer duration.

You'll get cool dreams, that's all..

It sedates you as much as a glass of warm milk, i.e. not at all.

Not a bit anxiolytic. Not an "antidepressant" either.

A rather effectless (and pointless) medication. Cool dreams is simply not enough.. No HPPD worsening though. Might mess up your liver because of the "helping" substances in the pill (read: heavy metals)

I stopped using it after ~6 months, it had no benefit simply.

I would also like to recommend some very mild, harmless, herbal anxiolytics:

Mint (most sorts): A little bit relaxing for mind and muscles.

Hops: Yup, the famous beer ingredient, provides the bitter flavour.

Mild anxiolytic and muscle relaxant, promotes sleep. Nothing close to a benzo, but on the other hand safe to use regularly (without alcohol, that is).. Extracts, fresh, or dried forms are to be prefered, not in beer due to the risk of alcholism.

No HPPD worsening on any of these herbs.

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Hey 415! Thanks for your comments. After trying mirtazapine for a bit longer (it was a couple of months ago, so I can't recall exactly how long, but I think it was 5 or 6 days) I can definitely relate to the "pro-depressant" comment. I'm not usually prone to depression but I felt absolutely anhedonic and grim and was a general pest to everyone in my vicinity while taking it! Definitely not pleasant. I'd have to agree that it is somewhat anxiolytic, though.

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When we got back from our walk we were sitting on a few big rocks just hanging out, I had already apologized for my first out lash and everything is back to normal, as we are sitting there B says something very slightly provocative (i cannot remember verbatim what was said" and I snapped out, I couldn't control what I was doing or saying, but I was standing up pointing my finger at B and cussing at him telling him to shut the fuck up or fight me, what was really weird was the fact that I had no control over what I was doing, the whole time I was thinking in my head "what am I doing? Why am I doing this? I need to stop yelling at him and let it go. Whats happening to me. I'm never gonna stop tripping. After that night I was kinda weirded out by the whole incident so I stopped taking any type of psychedelic, after a few months I started noticing that I was tripping constantly, especially in situations that made me nervous, like going to a court hearing, i was looking at the floor and i was seeing waves everywhere and books sliding in and out of the shelves. This constant tripping lasted for a while, I became a different person, It was like i developed ADD and anxiety, and my depression had worsened a lot. Me and my girlfriend broke up while i was going through this as well and it was extremely hard for me, I plummeted into a deep depression and didn't think I had ever truly loved myself. I was a big time party freak before I met my girlfriend and kinda mellowed out the year we were together, so after we broke up I kinda jumped right back into it, I started doing a lot of benzos because they made me feel numb, in the HPPD state I feel everything and the feeling is multiplied, so these were a quick addiction for me, although my HPPD subsided. I continued partying and doing drugs until I went to my freshman semester of college at, you guessed it WVU. As soon as I got down there I made some bad friends and was robbing people and doing pills and smoking like never before, I eventually had a close call and dropped out and returned home, when I got home I did the same old thing, robbed people and did pills, and I really needed something to change my life around quick. Then one night I was staying in a motel with a friend when he pulls out an ounce of mushrooms, Ahhhhh my friends at last. He asked me if he cared if he ate some, and i said as long as I can eat some with you. It had been really long since i tripped and this friend was my best friend for the past two years so I decided i was in a good environment with one friend, fuck it. We started tripping, and it was a trip like I had never had before, I ate 4.3 grams of caps and we blasted off into the unknown, after a while of tripping and happy laughs good visuals, we had to go sell a half ounce to someone about 20 minutes away, so we drove there just talking, no music the whole time. We talked about life and about where we were at and if we were happy. On the way back i started to notice that my eyes were going lazy and i was seeing one road for each eye that I had, So I was double visioned basically. I found it extremely hard to fight this so I just focused on one road and drove perfectly all the way back, when we got there we were still conversing and heading to get food, all the sudden, epiphany after epiphany, my vision closed in and formed one extremely clear picture, like I have never seen anything before and It was while I was saying how I needed to quit doing drugs and focus on my body and spiritual health, My friend says we opened our third eye, and I believed it, my whole life changed that day and i started loving psychedelics again, buying and using daily, I would micro-dose, i would take .5 in the morning and .5 around 3-6 pm, even though i wasn't doing it right i thought i was okay because i was only micro-dosing. I started getting into meditation and yoga and all these spiritual things, I had a few epiphanies while meditating that were very radical, like one was I felt a telepathic connection with the universe and was thinking with consciousness, I say consciousness because the image that came along with the thought was telling me that consciousness is one, we are all the same, so the first thing i thought to ask was whats the point of life? The response; Love, the point of life is to love everything and everyone, because no matter if I am human and dog is dog, we are both alive, thriving on this planet together, so If i have the knowledge to care for life on this planet I must.  This short lived high point in my life quickly faded weeks after when I noticed that I was tripping all the time again... It has been about 4 months since then and I am in the worst place ever, I cannot get myself to work, I cannot eat, I sleep surprisingly well though still. I have had crazy thoughts that pop into my head along with my visuals, like i saw visual snow, and i thought "well what if it is really something out there that I can see but nobody else can.." or "well if i believe that this room is moving then in my reality.. it really is moving.." And i become scared of these thoughts even though I don't believe them, It scares me to know that my brain is thinking them. I have debated suicide many nights, I consider myself a fuck up and a failure for all these evens that have happened, and now that Im thinking so much i begin to debate whether or not I am going crazy, I used to be such a smart kid, being able to off any teacher because I would find ways to prove them wrong, or being able to win any debate with friends because I knew more about the subject, I went from that to being the awkward kid who doesn't really talk a lot and has been sick twice in two weeks so he missed four days of work. I am beginning to fear that I can no longer do this. Hope this story was put together decently for you, I tend to get off topic sometimes, any thoughts comments would be appreciated dearly.   
       
      -E
    • By snowbaby
      Hi friends —
       
      My experience with HPPD started about 4 1/2 years ago, with a single dose of MDMA.
      For me, my symptoms are: anxiety/panic, DP/DR, visual snow, flashing solid colors, some tinnitus, and seeing movement in geometric patterns.
      Also: I used to always be a “crier” and someone who feels their emotions very deeply. During the first few weeks of HPPD, I cried so much, some times out of misery, some times out of gratitude to still be alive, some times because I heard some beautiful music and felt connected to it. But then after a few weeks my emotionality faded, which I assume must have been a psychological coping mechanism. I was so overwhelmed with anxiety that I had to shut down emotionally to stay sane. So no more tears or feelings of meaningful connection. I still want to feel those cry-feels so bad!.
      Over the next two years I got better at managing my symptoms, but saw little to no improvement in them. I was still smoking weed often (my bad) & still couldn’t really FEEL, and my anxiety was off the charts 24/7. It was absolute hell every waking day.
      A little over two years ago I started on 10mg Celexa, and the improvement I saw in my anxiety levels was life changing. Not gone completely, but I started feeling significantly better and my anxiety attacks became fewer and farther between. Worked my way up to 20mg, which is my current dose.
      A few months ago I finally found a neuro who is actually familiar with HPPD, who added Lamictal, ramping up VERY slowly (I only got up to 37.5mg/day). In the first month (2 weeks on 12.5, 2 weeks on 25) I started to notice my visual symptoms clearing up slightly and my brain feeling a bit clearer. It was actually the best I had felt since before HPPD and I was excited to continue ramping up on the lamictal, hoping it might help get me to a place where I can really feel emotions aside from anxiety again.
      After that first month though, things started to get unpleasant again. Bouts of anxiety attacks, some good days, some very bad. It felt like I had been consistently alright for a while, but now my worst symptoms are pushing their way back in. I also developed minor muscle twitches every few minutes, which was completely new. I was prescribed Klonopin after a particularly bad anxiety attack and now I take 0.25mg when I feel myself getting panicky. I don’t like it, but it does keep me from panic. I quit smoking weed then (a few months ago), but that hasn’t helped.
      My hopeful suspicion is that perhaps I’m experiencing SSRI “poop out” with my Celexa, and could therefore ideally switch SSRIs and continue with lamictal. My neuro says the only way to know that for sure is to come back off the lamictal and see how it feels to just be on the Celexa again. Back down to 25 from 37.5 lamictal and feeling a bit worse actually, but my neuro says I need to get down to zero and wait two months to see what the deal really is. I’d much rather keep my lamictal dosage as is, and try switching to a different SSRI, as that just feels more “right” to me - but she’s the professional so ...
      If it turns out that I’m actually not tolerating lamictal well, I am interested in looking into sinemet... it seems to have been a wonder drug for some people here, but I would be very worried about developing dyskinesia, as I work in a field where that could ruin my career.
      No targeted questions here really, just looking to share relevant experiences/advice with other HPPD’ers. ❤️
       
      PS: for anyone doing the ol’ downward mental spiral in these forums and feeling hopeless (like I used to), things WILL get better. I’m still having struggles but I’m not in hell like I used to be, and life is very worth living for me right now! I have my bachelors and masters degrees, a solid career at 25, wonderful friendships, and going by objective criteria, am a fully functional human being. You will be okay! Keep advocating for yourself!
    • By K.cokes
      Ive been accidently dosed like 8 tabs of liquid acid, and stupidly continued "tripping," even after that. So I started noticing a static over my vision, and I thought nothing of it at first. It has gotten much worse, and I haven't taken L.S.D in over a month. It especially gets worse if I'm smoking weed, it literally makes me have acid like visuals. Even without weed I get, tracers, halos around light, I get the pattern formation that forms when you take L, everything looks like it's shifting and melting, my anxiety has gotten progressively worse, I get visual snow, and I have pain behind my eyes sometimes, like a pressure almost, I have really bad after images, pretty much on anything bright, or lit up. Today for example I was driving, and looked at a stop sign when I looked down I saw the stop sign in my vision with my eyes open or closed. Does it ever get better, and is does it mean your brain is ruined?
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