Limitations
bipolar I depression, manic, sleep disturbance, manic/hypomanic, hypomanic, YMRS, depression, irritability
It is well known that the symptom network structure based on cross-sectional correlations between symptoms (edges) can be sensitive to small variations in participant samples due to the interrelated nature of psychopathology symptoms [Many YMRS items were rated 0 (absent) for some youth in this study. Relatively low base rates may have affected the adequate evaluation of these subthreshold (manic/hypomanic) features in the symptom network model. We investigated the combined effects of sleep disturbance and irritability in the acute study phase because over 90% of participants in this study had irritability at baseline. Consequently, it was challenging to separate the effects of irritability from sleep disturbance on treatment outcomes at week-6 in this dataset.Apart from sleep disturbance, other manic symptoms might also affect treatment responses in bipolar I depression in youth. The criterion based on the number (YMRS item score > 2 on 2 or more items) and severity (YMRS total score > 5) of the mixed (subsyndromal hypomanic) features did not predict treatment outcomes in this study sample, as assessed primarily by change in overall depression severity [