On the bookshelf of the psychology student treating Lisa there is a book titled "Did I Die or Not" by Dr. Marvin Monroe. Dr. Marvin Monroe was seen regularly in early Simpsons episodes, but later in the series his name is sometimes seen on a headstone, or alternatively he's seen in a background group of characters.
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The episode title is a reference to the graphic novel series "American Splendor".
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The episode won an Emmy Award for Outstanding Individual in Animation - character animation.
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The rock music playing during the "Sad Girl" show is actually the music from the Broadway show "Spider-Man: Turn Off The Dark", which was notorious due to production complications, mainly relating to stunt problems and technical issues, as well as constant rewriting of the book and score. The show was receipted by critics with mixed feelings, claiming the stunts and visual effects were great, but weren't so keen on the storytelling.
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