They're letting Jared talk a lot about spoilers:
Star Jared Padalecki says that Sam's experiences in Hell are soon going to boil over, and he will go "bat-ass crazy" and need to be put into an asylum. He also previews another part of Sam's big breakdown:
There's an episode that we're talking about right now where Sam isn't sleeping. The longest anybody's ever gone without sleep is like nine days, and they died, because your organs shut down. I wanted to make sure that we don't have an episode where Sam hasn't slept in a week, and he's losing his mind, and then he suddenly gets it together and helps save the day. I want him to be human, and I want him to be effed up. What's made these characters likable is that they are human.
He also reveals that Sam will be institutionalized in the episode that Misha Collins first returns as Castiel, which will shift the focus to Dean:
Sam never took offense to the fact that Cas had a beef with him. Sam's always been pragmatic and practical. He's like, 'Okay, I guess if I was talking to somebody who messed the whole world up, I'd be hesitant too.' I think with Dean, it's really hard for him to deal with Castiel's betrayal. We've seen Sam wrestle with visions of Lucifer, and now it's Dean's turn to have that kind of a story. We'll see Dean struggle to wrap his head around the Castiel issue. He's like, 'How do we forgive this guy? How do we trust him? That's how we got hurt; that's how we got burned.' Dean's once bitten, twice shy. We'll see him wrestle with some of his own demons.