Up All Night, Seeing Bugs, Depressed

Reader’s Question

I feel like something is going wrong in my head. I’m currently taking 50mg of Zoloft daily for panic attacks. I’ve been taking it for about 3 months. My family physician had me on Paxil for several months for depression and then the panic attacks started. The panic attacks seem to be among the list of ‘things’ going on. I can’t really remember when I started feeling like this (it may have been forever), but I have intense bouts of sadness followed by moments of extreme happiness. I’ve always kept a journal of my thoughts and feelings and read some of the entries, and I’ve noticed the pattern. It’s like being high on some super stimulant and then crashing. My brother loves my ‘high’ moments. He says that I do really fun things during them.

Then I hit a major dip in the road. My dad decided to have an affair with another woman. This resulted in my mother filing for divorce. I was devastated. I’m 31, so I don’t think it should have affected me like that. I don’t know why but I completely idealized and idolized my dad. When he had the affair, it was like he became this villain. There was no in-between because people make mistakes. Something in my brain switched off, and he was vile. There were times when I felt like I hated him, but I wasn’t allowed. I wouldn’t allow myself to hate him, and with this I’d punish myself for thinking such thoughts. I felt so much emotional pain that I wanted and needed a greater pain to cancel it out. That was when I started to hurt myself so I could feel better, but I still had this profound sadness. It was so profound that I wished my heart would stop so I wouldn’t feel the sadness anymore. I’ve contemplated suicide during these times, and I have also gone into fits of rage in which I have to be held down (thank goodness my brother was around). The rage is surreal because it’s like I’m watching someone else become extremely violent.

I started having panic attacks recently. I’ve also taken Wellbutrin, Topamax, and Paxil for depression. I have gone through bouts of complete confusion in which I just want to scream and pull out my hair, but now I’ve started to see things. Sometimes I see people walking in the road, and I have swerved to avoid them. Other times, I see insects. I know this may sound cliché, but that’s what I see. I can see them laying between the slats of the blinds in the kitchen window staring at me. The first time I saw the bugs was when I had stayed up for 12 hours. I write, and I was feeling really good and had energy to spare. I think it was during one of my happy episodes. I sat down at my computer at 9 p.m. Friday night and didn’t get up from the computer until 9 a. m. Saturday morning. I cranked out 20 or so pages of fiction. I wasn’t tired when I got up, but I started seeing the bugs. They were crawling everywhere, so I decided to go to bed to avoid seeing them. I slept for about 4 hours and was up again. My mom has caught me staring at things that only I could see. When she asks what I’m looking at, I reply that it’s nothing. I’m afraid to tell her of all the things that are happening to me. She is going through enough with this divorce, so I write about the things in my journal. I’ve mentioned that I think something is going on in my head to a few relatives. Some of them chuckle and tell me that if something was really wrong, I wouldn’t be aware of it. Is that true?

Psychologist’s Reply

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Lots of symptoms and issues in this question. I’ll first say that if something is wrong, the majority of folks are aware of it. In your three paragraphs I can provide some comments:

  • You’re showing signs of a Bipolar Disorder: wide mood swings, manic episodes (up all night, too much energy, etc), depressive episodes, and mind racing.
  • Hallucinations of bugs are more common in stimulant abuse but can also be caused by medications. Zoloft, for example, has a side effect of increasing Dopamine in the brain, a brain neurotransmitter that is associated with hallucinations. At such a low dose, this is probably unlikely but can’t be dismissed. Zoloft can also produce a hypomanic episode — again something we can’t dismiss. This can also occur with sleep deprivation, in manic episodes, and when anxiety is high. Anxious folks have auditory and visual misperceptions — hearing name called, phone ringing, car doors shutting — and seeing things out of the corner of their eye (usually down low).
  • The major finding in your situation is that you are undertreated. Zoloft 50 mg is a low dose and your symptoms are not likely to be managed on that dosage. I strongly recommend that you see a psychiatrist — the mental health professional best trained in using higher doses of medications and using multiple meds in combination. While a family physician may try to help, the presence of manic episodes, hallucinations, panic attacks, suicide thoughts, etc. tells us that you need more aggressive treatment.
  • I would also recommend that you seek counseling/therapy. You will need both monitoring while psychiatric treatment is underway and counseling to address your current family concerns.

Your situation is very treatable but it must be treated as aggressively and efficiently as possible. Trading a variety of low-dose medications is ineffective when considering the severity of your symptoms.

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