Also, hilarious that they were both dosing each other’s coffee — it wasn’t just House.

I didn’t really get this week’s medical mystery. Not that I’m a medical student or anything, but usually it’s not that hard to follow. But I had absolutely no idea what had happened after the episode was over. How did her head explode? Was that caused by the suicide attempt? Apparently, they wanted us to believe that.

It bothers me that people seem to think that “antidepressants” means “SSRIs.” Someone above mentioned Wellbutrin, an NSRI – which, yes, takes effect *immediately,* but certainly wouldn’t cause haziness, and even less so sleepiness. However, there’s no reason to limit antidepressants to the newer, chic-er reuptake inhibitors in general. Take Remeron/Mirtazapine: it’s part of the previous round of antidepressant types, tricyclics (between MAOIs and SSRIs). SSRIs are actually the slowest and least effective of antidepressants, but because of their generally smaller side-effect profile, are the vast majority of prescriptions. Remeron, however, acts immediately and is *far* more effective (at making people “happier,” ie, depression remission according to objective measurements) – it also causes haziness and improves sleep patterns, though tends to cause oversleeping and grogginess, especially in the first couple weeks of treatment. If Wilson knew his antidepressants, it would make sense for him to dole out the most effective antidepressant (Mirtazapine stomps on all SSRIs in remission metastudies), that wouldn’t also take weeks to establish a “level.”

Love how House BS’d the girl at the end with “Technically, all you have to do is promise me that you wont do it again and legally I can’t tell them.

Also, that’s the tiniest and least busy hospital pharmacy I’ve ever seen.

What was with the exploding head?

Wilson happens to yawn during the conversation in which he has just learned of Foreman’s resignation notice (at 7′:23″ in the episode). House picks up on that clue, pointing out that Wilson couldn’t possibly be tired late in the morning, drinking coffee moreover, nor could he possibly be bored with the conversation, and proceeds to start interrogating Wilson about it, starting off listing possible causes: “Vasovagal issue, maybe a heart problem.” Moments later (8′:35″), during a meeting with his team for the case at hand, House throws in the question “What is pandiculation symptomatic of?” (and here i had to look it up, and apparently it has more to do with stretching than yawning, the latter often being an accompanying phenomenon. Even the etymology of the word points to stretching. Wilson had not stretched, he had simply yawned. Hum.) Foreman starts with “Yawning is a symptom of fatigue or cholinergic excitation.” Chase offers “Cerebral tumor, epilepsy… ‘could also be a medical reaction to antidepressants or some meds for end-stage liver failure.” Later (25′:50″), when Wilson confronts House for having spiked his coffee, although still on the “speed”, he yawns again, at which point House resumes the interrogation about it, this time suggesting but either a cerebral tumor (in which case Wilson would have “only six weeks left to live”), or the antidepressants.

The Wikipedia article on “Yawn” seems to differ quite a bit on the causes of yawning. What say you?

Anderson, I thought the same thing about the macular biopsy. The macula lutea is the area where light is focused on the retina. Sticking a needle in there would cause irreparable vision loss.

Also, wouldn’t spiking someone’s coffee with drugs result in an arrest and immediate suspension of one’s medical license?