Start

Picture of Sophia Petrillo's frowning face from The Golden Girls.
Picture it! San Francisco, 2015
Portable tech was coming of age—it was the year of the Apple Watch.

Few people get the attention they need when starting an antidepressant. We built Start to fill in the gap, give people control, and help them find their way to something that works.

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The first line of depression treatment in primary care—antidepressants—work at best about 1/3 of the time. Millions of Americans are prescribed these medicines but don’t get the follow-up they need to find out whether theirs works for them.

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Start brought a clarity to the trial and error of this aspect of depression treatment and accelerated the trial and error process according to accepted best medical practices. It guided people through the initial period of adjustment to the medication, and providing actionable context at critical times about whether the medication and other treatment efforts are working. Apple recognized the app and we were a CareKit launch partner.

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People with depression can find themselves in a fog, ruminating on negative thoughts, and struggling to see a path towards improvement. Start is designed for minimal interaction—just enough to help people take action. It provides pharmacist guidance about what to expect, daily tips, and optional pill reminders. Data collection is sparse—just every couple of days. No "daily dashboard" is provided; instead, a Start user gets a bi-weekly progress report that carefully reflects back and contextualizes the person’s experience in research about evaluating and making treatment decisions. These are explicitly designed to be useful both to them and their clinicians, with whom they can easily share the report.

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I turned research with our iodine.com users on their latent needs into this project, conceiving of its program from scratch, gathered evidence to support the mission, and guided product development. Michael Schultz and Ross Patton did terrific design work and Marc Mendiola and Hans Nelson built the majority of the key parts of the app.

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