New Telehealth Service Aims to Assist Patients in Gradually Discontinuing Antidepressants

Ariella Sharf, who began taking antidepressants during her college years over a decade ago, faced uncertainty when she decided to stop her medication last year. After moving across the country, she found herself disappointed in the lack of support from her psychiatrist and felt her primary care physician was not adequately equipped to assist her. In her search for help, she turned to Outro Health, a telehealth startup that aims to provide support for individuals seeking to taper off antidepressants.

Launched last month in the United States, Outro Health is currently operational in seven states, including California and New York. The service targets the increasing number of Americans on antidepressants, with over 11% of U.S. adults reported to be using these medications in 2023, according to the Centers for Disease Control and Prevention (CDC). Notably, women are more than twice as likely as men to be prescribed these drugs.

Research indicates that approximately one in six individuals who cease taking antidepressants may experience withdrawal symptoms such as nausea and dizziness, particularly if the discontinuation occurs abruptly. Some studies suggest that adverse effects might be even more prevalent among those who have been on the medication for extended periods.

Outro Health offers a monthly subscription starting at $125, pairing patients with clinicians who guide them through personalized tapering schedules. This approach typically includes weekly or monthly consultations. Currently, Outro employs a small team of medical professionals, including nurse practitioners with expertise in psychiatry, who are supervised by psychiatrists. Although patients must pay out-of-pocket for the service at this time, there are plans to accept insurance in the future.

The startup focuses on tapering methods for commonly prescribed antidepressants, including selective serotonin reuptake inhibitors (SSRIs) such as Lexapro and Prozac, as well as serotonin-norepinephrine reuptake inhibitors (SNRIs) like Pristiq and Cymbalta. In the coming year, Outro intends to expand its services to include tapering programs for stimulants and benzodiazepines, which are frequently prescribed for anxiety and ADHD and can also lead to severe withdrawal symptoms.

Sharf, who became one of Outro's inaugural patients during a pilot program in California last June, expressed satisfaction with the tailored approach to her tapering process. Twelve months into her journey, she continues to receive support from Outro at a pace that suits her needs.

Patients who enroll with Outro typically follow a tapering strategy known as "hyperbolic tapering," developed by one of the company's cofounders, British psychiatrist Mark Horowitz. This method involves a gradual reduction in medication dosage, slowing the rate of decrease over time to ensure smaller doses are administered as the process continues. To facilitate this, Outro collaborates with compounding pharmacies to create custom formulations of generic antidepressants in significantly reduced dosages not available through conventional channels.

Horowitz, who has emerged as a prominent figure in the field of medication tapering, shares his insights stemming from his own challenging experience with discontinuing antidepressants over a decade ago. After developing a personal tapering plan that involved meticulously controlled doses, he faced severe withdrawal symptoms that took years to fully resolve.

As a clinical research fellow with the UK's National Health Service, Horowitz has advocated for revised clinical guidelines regarding the cessation of psychiatric medications. His objective with Outro is to introduce effective tapering methods to a North American audience.

Brandon Goode, Outro's CEO, brings a background in pharmaceuticals and telehealth to the venture. His previous experiences included positions at Novo Nordisk and a psychedelic therapy startup. The inception of Outro was partly inspired by inquiries about using psychedelics as an alternative to antidepressants, indicating a potential demand for assistance in tapering off these medications.

Despite the growing interest in mental health solutions, launching a service centered around discontinuing psychiatric medications comes at a sensitive time. Public figures, including the U.S. Secretary of Health, have raised concerns about the over-prescription of antidepressants, leading to debates over their safety and effectiveness.

Horowitz acknowledges some of the apprehensions regarding the over-prescription of antidepressants and the challenges associated with withdrawal. However, he emphasizes the importance of informed navigation through the complexities of medication cessation.

Among mental health professionals, there is a rising call for reevaluation of how withdrawal from antidepressants is approached. Some experts advocate for customized tapering plans to address individual patient needs effectively.

While some psychiatrists argue that simpler tapering methods may suffice for many patients, Horowitz believes that the current levels of SSRI usage warrant careful consideration of the societal factors contributing to mental health issues.

Offering an alternative to conventional health startups, Outro aims to assist individuals in discontinuing medications rather than initiating them. Its website employs familiar design elements found in the telehealth sector, promoting an introductory offer to potential clients.