What is Start?

Not on Android? Click here for the iPhone link.

Start is an iOS app that takes someone through a six-week program to
help them figure out if their antidepressant is working for them.

The Science

Start combines clinically validated tools, best practices, and what works in research to help you understand and take action.

Who is Iodine?

Iodine is a new kind of healthcare company on a mission to improve medicine by helping people find what works best for them. We believe in the power of design and technology to make complicated decisions clearer, and in the power of people to make good decisions.

We help you turn your experience into better medicine.

Want to know more? Check out our about page.

Iodine works with foundations and communities, not Pharma.

How does Start work?

A Start user tracks their medication, mood, and issues that are important to them—data points. Every two weeks, they get a personal report showing them what they recorded over the last two, four, and six weeks—like a summary of a data diary or journal. This report is for the Start user, and can be shared with their doctor. A user can discontinue use of the app at any time.

What exactly does “figure out if their antidepressant is working for them” mean?

Start is a way for someone to record data points that provide self-reported clarity about their own experience. Through reports, a Start user can see how factors that may relate to their depression and its treatment have changed over time. They can look at these factors together, and evaluate for themselves whether they are seeing progress that they want to see. The factors are:

  • Do they report taking their medication regularly, as prescribed?
  • Do they report being satisfied with their medication overall?
  • Do they report feeling down or finding little pleasure on a sub-weekly basis?
  • How often do they report having issues—side effects, or symptoms that are important to them to track—on a sub-weekly basis?
  • How often do they report depressive symptoms over the past two weeks?

Armed with detail about these factors, someone can look at changes or their progress and have a data-informed discussion with their doctor about their treatment.

How does the doctor fit into this?

Start is designed to help its user record data about their own experience, which they can share with their doctor to make a clearer determination about treatment progress.

Where did this idea come from?

The medical literature shows that finding an effective antidepressant is a trial-and-error process for many people—it can take many months. In our research, we’ve found that a huge percentage of people taking antidepressants who visit our website (which provides medication information) do not know whether their antidepressant is working for them. And in most instances, doctors who prescribe antidepressants do not have a systematic, regular way of knowing their patients’ progress in terms of medication adherence, symptoms, and life changes. Indeed, follow-up may happen at a pace and with a lack of clarity that extends the trial-and-error process.

Start aims to improve that follow-up—and consequently the trial-and-error process—by giving people a tool to systematically record their progress while taking an antidepressant. We believe that this regular, crystallized self-reported data—as reflected back to a Start user in a report every two weeks—will provide greater clarity to both them and their doctor.

Start facilitates shared decision making, in which both the doctor and patient (among others) make informed treatment decisions together—where informed means including the subjective experience, needs, and values of the patient, besides other kinds of medical evidence and clinical rationale. Shared decision making is specifically noted as a healthcare system delivery reform in the Affordable Care Act, and referenced in clinical practice guidelines for treatment of depression.

What is the six week program, and why is it a six-week program?

Widely used clinical practice guidelines for treating depression and other medical literature indicate that response to the most common antidepressant medications (those covered by Start) can and should be evaluated within this timeframe. The literature indicates that:

  • Some people show response to an antidepressant medication (at a given dose) by two weeks, but most do not.
  • By four weeks, if an antidepressant medication is working, some response should be evident.
  • By six weeks, if an antidepressant medication is working, the depth of response can begin to be evaluated. Remission of symptoms of the depressive disorder is a typical target, though not always achievable.

Guidelines go on to say that if the response is deemed adequate—a determination made collaboratively by the doctor and patient—it is ideal to continue therapy for up to 6 months or longer. If the response is deemed inadequate, the doctor and patient can engage in a process of shared decision making to either continue, or alter therapy—by changing dose, augmenting with another therapy (e.g. medication or psychotherapy), trying a different medication, trying a different kind therapeutic modality (e.g. psychotherapy), or discontinuing treatment.

Guidelines encourage evaluation of response with clinically-validated instruments, including some that are self-administered by the patient. The PHQ-9 is one such instrument, and is used by Start. However, in clinical practice a variety of barriers exist to conducting such rigorous follow up on this tight schedule—it’s unlikely that a typical patient will be seen every two weeks, and be systematically recording their experience and response to the antidepressant medication.

That’s where Start comes in. The six week program is roughly as follows:

  • At start, a clinically validated screening questionnaire (PHQ-9) is taken. It asks the user to reflect on the past two weeks.
  • Every two days or so, questions about medication adherence, medication satisfaction, day-to-day mood, and/or important issues (symptoms, side effects, and so on) are answered.
  • At two weeks, a PHQ-9 is taken. The self-reported data from the previous two weeks is assembled into a report, with simple graphical representations of the data that summarize it. The report is contextualized with general information from the clinical practice guidelines and medical literature that response is rarely seen at this time point.
  • At four weeks, a PHQ-9 is taken. A new report is generated, summarizing the self-reported data from the previous four weeks. The report is contextualized with general information from the clinical practice guidelines and medical literature that a response is often evident at this time point.
  • At six weeks, a PHQ-9 is taken. A new report is generated, summarizing the self-reported data from the previous six weeks. The report is contextualized with general information from the clinical practice guidelines and medical literature that depth of response is often evaluated at this time point.

With each report at two, four, and six weeks, the Start user is prompted to continue using the app, if they wish. They are also prompted with a question about whether they wish to speak with their doctor about their experience. They may (if they wish) bring their iPhone or iPad to clinical visits, to share the Start report with their doctor.

Is Start evidence-based?

Yes. Start’s program is based on widely used clinical practice guidelines, and other medical literature, including systematic reviews.

Does Start give treatment advice?

No. Start reflects someone’s experience—as they reported it—back to them, and puts it into the context of evidence-based medical practices. It never advises someone to make a particular decision. Start does remind its user that they can speak with their doctor if they are concerned about anything related to their treatment—side effects, progress they’re making, or questions about their medication.

Who is Start for?

People over the age of 13 who are starting a new antidepressant treatment (i.e. a medication at a certain dose) for a depressive disorder. People who are just starting means they’re within one week or so of their first dose. That way they can track their experience from the get go. If people are well into treatment, they can still track their experience but no contextualization based on the 6 week program—just regular reports reflecting their self-reported data.

Have doctors reviewed Start? Where does its medical data come from?

Iodine engages two University of California San Francisco physicians with expertise in medication adherence and primary care treatment as advisors. These doctors have reviewed Start and continue to do so on an ongoing basis to ensure that it conforms to both best clinical practices, and can serve as a helpful tool for doctor-patient decision making around antidepressant treatment of depression. Medication and depression symptom information referenced in Start comes from several sources: Our team of pharmacists and doctors, who have created or reviewed all such information on our website, Iodine.com trustworthy sources of evidence, including systematic reviews and FDA-mandated product labeling for pharmaceutical products.

Is data shared with drug companies or other organizations?

Aggregated statistical data—such as the most common issues raised by men 18-34 taking a certain medication—may be shared with Iodine partners. Personally identifying information, individual data points for a Start user, is private. See Iodine’s privacy policy. Iodine has no relationship with drug companies.

Is Start free? Is it available for Android?

Start is free. It is only available for iOS 8 and later.