Start, the new Apple CareKit app, helps people suffering from depression identify effective medication treatments significantly faster than existing methods. This app marks the first clinical integration in the mental health sector.
Global Problem, Tough Remedy
Start is designed to help improve the management and treatment of depression. Worldwide over 350 million people suffer from depression, but despite the extent of the condition, it is remarkably hard to treat.
I spoke with Thomas Goetz, co-founder and CEO of Iodine, developer of Start. (If his name sounds familiar, it’s because he is the former executive editor of Wired and a published author.)
“Depression is entirely subjective,” he said. “It’s essential to help people actually process their own experience, and then to help them measure progress.”
Depression can be intermittent or chronic. Depression also occupies a wide band of negative feelings, from low self-worth to suicide ideation, and can impact work and family life. A combination of therapy and medication is the usual treatment option for moderate to severe cases.
There Is No Magic Cure
One major problem with the medication is that while many remedies work for some people some of the time, there are none that work for all people all of the time. Treatment demands a lot of trial and error, while patient suffering continues.
“Depression is often a fog to treat,” says Goetz. “Both for the patient and the doctor. It’s hard for people to discern whether they’re getting better because it is experienced differently by different people, and because it takes several weeks for a new medication to take effect, it is hard .”
Traditionally, the patient’s journey from diagnosis to something like resolution can be extensive. Start, with CareKit, aims to reduce the time between diagnosis and identification of suitable medication.
How the Apple CareKit App Helps
Patients of the Apple CareKit app are equipped to track their progress with antidepressants and send regular progress reports to their doctors, all from within the app. The app is being clinically integrated with Mindful Health Solutions, which uses the information to more accurately monitor the effectiveness of antidepressants on their patients.
This is more than an administrative exercise, Goetz explains. “Start works for people because it’s more than just a mood tracker or a pill reminder. People share their experiences, and then that experience is synthesized into a Progress Report. That report shows a very clear map of their progress (or lack of progress) every two weeks. This report is powerful because it measures depression severity on a clinical scale and it visualizes progress on what matters to the individual.”
The app also provides tips and shared experiences from carers and sufferers to help users feel less alienated inside their condition. “We’ve found our users are hungry for understanding how their personal experience maps against that of others with depression. This guidance helps keep people to get better,” Goetz explains.
Good Response So Far
The evidence seems promising. After 6 weeks, 46% of Start users report that they’re responding well to their treatment, compared to 33% of antidepressant users who do not use the app. After four weeks, Start users see an average improvement in their depression scores of nearly 6 points on the 27-point PHQ-9 scale.
“The most tangible benefit we see is that we help people find what works, faster,” Goetz said. The app helps patients respond to the medication at higher rates than usual. This help allows patients to switch from medication that is not working faster than in usual care. “About a month on average, for users of our app, compared to about 3 months in usual care,” he said.
Ultimately, people get to find the treatment that works for them faster. “Given that the typical antidepressant is only effective for about 1/3 of people, helping people move along faster is a real need,” he said.
On Apple CareKit and Digital Health
Goetz praised Apple’s CareKit, calling it “terrific” due to how developers thought about the user experience in connection with the patient/doctor relationship. “It really created an intuitive framework for connecting patient-reported data to the clinical care setting,” he said.
One weak point, at least in the current implementation of CareKit, is a lack of integration with the doctor’s office. For example, it doesn’t (yet) plumb into caregivers’ systems. To get around this, Start integrates electronic faxing to send progress reports to physicians in PDF format. Doctors can then port this into their own EHR (Electronic Health Records) system.
How does Goetz see such remote monitoring within future medical care? “We think finding ways to efficiently measure real-world experience, using technology to make it cheaper and easier to understand the patient experience, is a huge opportunity,” he said. “We think that Iodine is helping bridge this divide by more effectively connecting people to their care providers.”
The WHO provides a useful factsheet you can reference if you or someone you know may be suffering from depression. The US National Association on Mental Illness provides some helpful support information.