2026 may be remembered as the year psychedelic medicine crossed into the mainstream. A federal push to accelerate treatments for serious mental illness, FDA fast-track review for psilocybin and an MDMA-like compound, and a national conversation about access have put approval within sight — possibly within months.

I think that’s genuinely good news, especially because it will encourage more research on their uses and effectiveness. . For people with treatment-resistant depression or PTSD who have run out of options, these therapies may offer real relief, and the evidence behind the leading candidates is stronger than at any point in my career.

But I want to raise something that rarely makes it into the excitement.

For a small fraction of people, the perceptual changes psychedelics produce don’t fully switch off. Weeks, months, sometimes years later, they are still seeing visual snow, trailing images, halos around lights, shimmering static across their field of vision — often accompanied by anxiety, depersonalization, and the frightening sense that their perception has been permanently altered. The clinical name is Hallucinogen Persisting Perception Disorder, or HPPD. It overlaps with Visual Snow Syndrome, and it is real, under-recognized, and frequently misread as anxiety or a primary psychotic process.

I say this as one of a small number of psychiatrists who has spent several years evaluating and treating these patients. In the past seven years, I have seen more patients with HPPD than most psychiatrists will see in a lifetime. What strikes me most is how alone they tend to feel. Many have been told the symptoms are “in their head,” or that they will simply pass. Some are misinformed that they are psychotic and are inappropriately treated with drugs usually used to treat schizophrenia or bipolar disorder. (Antipsychotic medication usually makes the visual symptoms worse.)

Many individuals with HPPD blame themselves. Almost all describe how hard it was to find a clinician who even recognized what they were describing. Most psychiatrists have never even heard of this condition. This contributes to isolation and withdrawal, sometimes leading to feelings of hopelessness.

None of this is an argument against psychedelic therapy. It is an argument for building the guardrails now, while the field is still deciding what responsible practice looks like. As access expands — through clinical programs, and inevitably outside them — the number of people exposed will rise, and so will the absolute number who develop persistent symptoms, even if the percentage stays small. Curiously, reports of HPPD occurring among patients treated in academic research settings, such as the Johns Hopkins Center for Research in Psychedelics and Consciousness, are extremely rare.

So, what would responsible rollout include? A few things I would want to see:

Honest informed consent that names persistent perceptual effects as a possible outcome, not just the transient experience.
Screening and history-taking that flags people who may be more vulnerable.
Follow-up that specifically asks about lingering visual and perceptual changes, so they are caught and validated early rather than dismissed. Clinician education, so the first doctor a distressed patient sees actually knows what HPPD is.

The organizations moving fastest right now are the drug developers and the platforms preparing to deliver these treatments at scale. The pharmas that build this kind of safety scaffolding into their protocols — rather than bolting it on after the first wave of harmed patients — are the cautious ones that will likely prove more trustworthy. In addition, the number of academic research centers specializing in applications of psychedelics to difficult-to-treat mental disorders (e.g., treatment-resistant depression and PTSD) is growing rapidly and access to clinical trials is improving 

The promise of psychedelic medicine is encouraging. But safety concerns are real and require attention. If you are working with psychedelic therapy — as a clinician, a developer, or a regulator — I would genuinely like to hear how you are thinking about this. What does responsible monitoring look like to you?

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