Asenapine in the treatment of acute mania in bipolar I disorder: Outcomes from two randomized and placebo-controlled trials

chronicity and frequent recurrences. We investigated the long-term outcome of a regionally representative psychiatric MDD cohort comprising mainly outpatients. Method: The Vantaa Depression Study included 163 patients with DSM-IV MDD (71.8% of those eligible) diagnosed using structured and semistructured interviews and followed up at 6months, 18months, and 5 yearswith a life-chart. The effects of comorbid disorders and other predictors on outcomewere comprehensively investigated. Results: Over the 5-year follow-up, 98.8% of patients achieved a symptom state below major depressive episode (MDE) criteria and 88.4% reached full remission, with themedian time to full remission being 11.0months. Nearly one-third (29.3%) had no recurrences, whereas 30.0% experienced one, 12.9% two, and 27.9% three or more recurrences. Double depression, cluster C personality disorder, and longer MDE duration prior to entry were the most significant predictors of longer time in achieving full remission. Severity of MDD and comorbidity, especially social phobia, predicted probability of, shorter time to, and number of recurrences. Conclusion: Previous literature on mostly inpatient MDD may have, by generalizing from patients with the most severe psychopathology, overemphasized chronicity of MDD. The long-term outcome of MDD in psychiatric care is variable, with about one-tenth of patients having poor, one-third intermediate, and a half favorable outcomes. In addition to known predictors, cluster C personality disorders and social phobia warrant further attention as predictors of MDD outcome among outpatients.