Kristin Myers: Now, roughly 50 million Americans take an antidepressant. Now, the average person has been on one for more than five years. Now, the study that got those drugs approved ran only a few weeks. There is an enormous medical infrastructure for starting people on these medications, but there is almost none for stopping them.
Now, my guest is building a company in that gap. Now, before we start, we have a bit of a disclaimer. Now, we do not want anybody to just change their medication because of a television segment. That is a conversation for you and your medical provider. We will be talking to Brandon Goode, co-founder and CEO of Outro.
But the road from an idea to the opening bell starts right now.
Millions of Americans take antidepressants, but what happens when a patient and their doctor decide it may be time to come off them? Well, for many, Brandon Goode says there’s no clear roadmap, and Brandon knows that challenge personally. His own experience inspired him to co-found Outro, a virtual clinic focused specifically on helping patients safely taper off psychiatric medications under clinical supervision.
The company combines specially trained clinicians, personalized tapering plans, patient monitoring and technology designed around deprescribing. And investors see an opportunity. Outro has now raised $7 million across its pre-seed and seed rounds. This funding will help the company grow its clinician network, expand into additional drug classes, and integrate AI into its clinical workflows.
Now here comes the real test. Can Outro take specialized support for deprescribing, something largely missing from traditional healthcare, and build it into a scalable new category of care? From Startup to Stock Exchange, Brandon Goode is next.
And joining us now is Brandon Goode, co-founder and CEO of Outro. Brandon, thank you so much for joining us today.
Brandon Goode: Thanks for having me.
Kristin Myers: So as I mentioned, you are the co-founder of Outro. As your hat says, the deprescribing company. We’re going to get into that in a second. So your background is actually in public health policy. You’ve worked in health systems in five countries, I’m seeing here. So how did you end up building this virtual clinic to help people get off of antidepressants?
Brandon Goode: Yeah. Well, I’ll be quick on the backstory, but I always wanted to get into medicine. I think, like a lot of people, personal family experience, engaging with the medical system. I’m from Toronto, Canada, originally, moved to the US for school. And then really just that was my first foray into learning how different healthcare systems were, which led me into public policy and actually spending three years at the start of my career at Novo Nordisk.
So at Novo Nordisk, I was responsible for building the GLP-1 and obesity markets, which are very successful, very popular now. I think I maybe did too good of a job. Did it too well.
Kristin Myers: Yes.
Brandon Goode: And, you know, I knew obesity wasn’t as simple as take a drug every day for the rest of your life. So I tried to pitch a business case to leadership to actually do research in how people could get off GLP-1s eventually, right, when they lose the weight. What other support structures could be put into place so they could discontinue the medication, keep their weight off, live a good life? And I was met with, “Well, Brandon, we take them off the drugs in clinical trials and they gain the weight back. That means obesity is a chronic disease and they need it for life.”
And the quote I’ve been using recently is from Warren Buffett, where he says, “Never ask a barber if you need a haircut.” So most of this research is done by pharmaceutical companies, and they are only really going to do research on starting the drugs. And then they educate the doctors. They partner with the universities.
So I realized there that, you know, in order to actually do work studying how people can safely get off long-term medications, you would have to do that outside of the pharmaceutical system. That’s where I met my co-founder, Dr. Mark Horowitz, who I can talk about, and really realized one of the biggest areas that we needed to solve this problem for first was antidepressants and psychiatric medications in general.
Kristin Myers: Okay. So talk to us a little bit more about the core idea, because your site says that withdrawal is routinely mistaken for relapse. What does that look like in a doctor’s office, specifically for folks that are on antidepressants?
Brandon Goode: Yeah. So for antidepressants specifically, like you mentioned at the start, the studies that were submitted to the FDA, the clinical trials, they last 8 to 12 weeks, sometimes as short as six weeks. And withdrawal symptoms, one, aren’t really looked for when it comes to stopping antidepressants. And these studies are very short term.
So as my co-founder says, in the real world, people are using these drugs for years, right? As we heard, on average more than five years. Now, guidelines recommend at least 12 months of treatment. The studies on withdrawal symptoms are 6 to 12 weeks, he says. You know, that’s like crashing a car into a wall, crash safety tests on a car at five miles per hour, and then saying it’s safe.
The longer you use a drug in the real world, the more likely you are to get withdrawal symptoms. And it’s a basic rule of pharmacology that when you stop a drug, whether it’s, you know, opiates, benzos, caffeine, nicotine, you will get withdrawal symptoms because you developed a physical dependence on the drug. We seem to have kind of thought antidepressants were these magic pills that didn’t have those. There’s some pharmaceutical company strategy behind that. But it’s time to correct those wrongs, both for the sake of patients and clinicians who want to do well by their patients.
Kristin Myers: So there’s something called hyperbolic tapering. I had never heard of that until, you know, chatting with you. So explain what that is to anyone that’s watching that might not have heard of that.
Brandon Goode: Yeah. So I guess it’s a challenge to find a simple way to explain it, but I think I can. So we have an intuitive idea that when you double the dose of a drug, it doubles the effect on the brain or the body or the receptors. So let’s say going from 5 mg to 10 mg of Lexapro, you’d think that would double the effect. From 10 to 20, that would double the effect. But that’s actually not what happens for all drugs. Rather than a linear relationship, it’s a hyperbolic relationship. It’s like a law of diminishing returns.
So small doses have a much bigger effect on the brain, and then that effect tapers off as you reach higher doses. So that means when backing out of the drug, as you get closer to zero, there’s bigger and bigger drops in the brain, which are responsible for the withdrawal symptoms. So the reverse of that same curve, going from 20 to 10 isn’t actually halving the effect, going from 10 to 5 isn’t actually halving the effect. And the biggest cliff is actually between the lowest dose you can get at your pharmacy and zero. I’m not sure if that was purposefully designed.
Kristin Myers: That makes sense, and I hope everyone at home remembers their algebra, remembering a curve. But investors might think about this in terms of making your first million is always harder than getting from your million to your ten. [Brief crosstalk unclear.] Think about it.
Okay, so talk to me a little bit about why the folks that are prescribing the medicine, the doctors, the physicians that are actually putting folks on this medicine, shouldn’t also be the ones responsible to help them stop. Talk to us a little bit about why this gap even exists for your company to come along and help folks get off some of these medications.
Brandon Goode: Yeah. It’s interesting. So there’s a couple of ways to look at it. One is, depending on the study, 75 to 80% of antidepressant prescriptions are actually written by primary care doctors. They’re already overloaded with work, right? The process of deprescribing, and this has been said by the psychiatrist who developed the DSM-IV, he said deprescribing is much, much harder than prescribing. It’s very easy to get on a drug. It’s very hard to get off it. We can’t expect primary care providers to be tasked with that.
Even psychiatrists themselves: one, the reimbursement infrastructure isn’t great to incentivize getting people off the drugs. They don’t have the clinical training, and they don’t have the wraparound supports and other pieces of infrastructure that are needed. Monitoring symptoms between appointments, providing psychological support throughout, and actually working at scale with compounding pharmacies that can make these custom dose sizes that are needed to follow that hyperbolic curve.
Kristin Myers: And we’re going to talk about those compounding prescriptions in just a second. But I want to talk about how it actually sort of works, right? If someone wants to sign up for the program, is it their doctor that signs them up for it? Can I, as the individual, sign up for it? Who signs us up? And then once that sign-up happens, how does it essentially work from there? What would a user be seeing once they’re on your platform?
Brandon Goode: So it’s a very modern virtual care platform. People can come directly, which is what has happened mostly so far. And more and more providers are also referring, including psychiatrists who know they need extra support to do this. So you’d come through, you would go through the onboarding flow, answer a quick survey just to make sure that, you know, there’s no deal-breakers, so to speak, for virtual care, that it’s the appropriate level of care.
And then they would book an evaluation with one of our clinicians, so mainly psychiatric nurse practitioners who are supervised by our psychiatry team. And when they’ve filled out that medical intake, they book their one-hour evaluation. The clinician determines if they’re a fit to try tapering off their medication with us, and then we’ll build them a custom taper plan that’s based off my co-founder’s work, looking at different variables like what drug they’re on, how long they’ve been on it, if they’ve tried to get off before, how severe their withdrawal symptoms were.
And they join our program and typically have one to two appointments per month. That’s where they’ll review their past withdrawal symptoms and reduce their next dose. We’ll fulfill the compounded medication for them. And then with our app, we track their symptoms and can check in with them via message. And we’re building a lot of lifestyle medicine classes and peer support groups as well, so people can start building the skills to prepare for a life without medication.
Kristin Myers: Okay, so to that point, because obviously what you’re talking about is helping people get off of this medicine and manage their withdrawal, which, as you mentioned earlier, they’re going to experience because they were on a prescribed medication. But are you also monitoring, at least in terms of [unclear] for antidepressants, their mental state as well, to ensure that, okay, you’re coming off of this and we’re helping you manage withdrawal, but we also need to ensure that the symptoms or the things that actually brought you to this medication aren’t popping back up again?
Brandon Goode: 100%. So at baseline, we do the standard depression and anxiety screeners, and that goes into our decision of if it’s the right time. And then every three months of their tapering process, we also do the PHQ-9 and GAD-7 to measure for depression and anxiety.
And I think one really important thing for people to know is, you know, when coming off a drug that you’ve been on long term, like an antidepressant, withdrawal is actually the rule and relapse tends to be the exception, right? It’s a scientific truth that you will get withdrawal. As you said, hyperbolic tapering should minimize that withdrawal.
But with depression, a lot of people have been told, “Oh, it’s caused by a chemical imbalance or low serotonin.” That was a myth perpetuated by pharmaceutical companies. Many, many commercials, Zoloft, blah, blah, blah, saying it was an imbalance of neurochemicals in your brain. When you look at surveys, 90% of the general public believe that to be true. And it’s a myth. It’s been long debunked, but it perpetuates, right?
And so that’s one of the big fears that people have, like, “Oh, I am a depressed person genetically,” right? And that’s one of the fears that we help address with people and help them understand, you know, depression can naturally resolve and you can live a life without your depression returning. You need to worry about withdrawal symptoms, which we’ll help you with. And we can also look at holistic skills for maintaining good mental health long term.
Kristin Myers: So before we go to break, I want to ask you about the licensing, because you mentioned that folks are speaking with a clinician, I’m assuming a licensed medical practitioner.
Brandon Goode: Yeah.
Kristin Myers: So you’re in 14 states now. What are some of the constraints you’re seeing in terms of licensing clinicians, regulations, which I imagine also are attached to those compounding pharmacies and those prescriptions as well?
Brandon Goode: Yeah. So the compounding pharmacies are independent of us. That simplifies the complexity now, but we’ll look to integrate that in the future. We focus very much on the care side for now. And, you know, we build relationships with these pharmacies. We vet them to make sure that they’re good quality and a good experience for our patients.
On the clinician side, there’s huge resonance from clinicians. The average clinician sees this gap. You know, this problem has been on the tip of their tongue, and finally there’s a place to voice it. So we’re seeing a lot of clinicians really, really interested in working with us. But especially starting out, as we build this infrastructure, we have to be very thoughtful of the clinicians that we bring on. You can’t take any old clinician off the street and just teach them deprescribing immediately. So we’ve been very thoughtful about that. And, you know, as we grow and reinforce our clinician training and clinician support, then we’ll gradually expand, you know, nationwide.
Kristin Myers: Okay. So there is almost like a training program that clinicians are going through.
Brandon Goode: Yeah, we have a training program, you know, designed by my co-founder Mark Horowitz, who literally wrote the textbook on it. And yeah, it’s been wonderful to see these clinicians grow and evolve, and several clinicians are now tapering over 100 patients, which I think is a record, probably.
Kristin Myers: Now, here’s what the evidence actually shows. Antidepressants were approved based on studies running a matter of weeks, and the average American taking one has been on it for more than five years. But when it comes to withdrawal, the estimates vary widely. One analysis puts the percentage of people who experience symptoms at 56%. Controlled trials put it nearer 15, though most of those patients had been on the drugs for only a short period of time.
Now, about half of people who discontinue relapse within a year, and for some people, staying on is the right answer. But what the United States does not have is a standard for how to stop. And that is the gap that Outro is building into.
We’re back now with Brandon Goode, CEO and co-founder of Outro. So, Brandon, I actually want to ask you really quickly about that relapse stat, because that seems like a pretty hard one. Half of the people who come off these medications relapse within a year. So when somebody comes to you and says, “Hey, I want to get off of these medicines, off of these drugs,” how do you tell the difference between someone who is ready to stop and someone who should stay on?
Brandon Goode: Yeah, I’ll start with the definition of relapse as well. And as I mentioned, there are some first-principle errors with how these studies were designed and are analyzed. Like I said, people look for relapse. They don’t look for withdrawal. So one, it’s very easy to confound and mistake withdrawal for relapse in these studies. And two, what was the tapering method employed when people were taken off these drugs in these studies? It would be a matter of weeks. It would be a taper method that’s not minimizing withdrawal, which would therefore increase the risk of relapse.
So there’s a few hallmarks. And I’m not a doctor, but I’ve learned a lot from my co-founder. But a few hallmarks of withdrawal versus relapse are, you know, how do they compare with the original symptoms you were experiencing? There are psychological symptoms that can look a lot like relapse: anxiety, low mood. There can be cognitive symptoms like cognitive slowing, problems sleeping, memory loss. And then there can also be some physiological symptoms that are very distinct to withdrawal. One of them would be brain zaps, like people experience this electric shock-like sensation when they move their head or move their eyes.
So there are a few distinguishing symptoms that my co-founder has done research in, but it’s very important to have the right training and the right monitoring to actually be able to understand what somebody is truly experiencing.
Kristin Myers: Right. So the hyperbolic tapering, I want to talk about the success of that. Your website says it has a success rate seven times higher than the standard protocols, but scientific reviews say that no randomized trial has shown it’s better than conventional tapering. So where did you guys get that seven times better from?
Brandon Goode: Yeah. So on our, we explain it a little bit deeper on our references section. But essentially, when we look at the trials that have been done, so in the Netherlands, actually both of these studies were in the Netherlands. When we look at a typical primary care pattern of people stopping antidepressants, the success rate looks to be between 6 and 10% of people getting off them.
They did a study on a hyperbolic taper off of antidepressants in the Netherlands as well. They called it the Horowitz-Taylor method, after my co-founder, and they found that in the long-term follow-up period, one to five years off the medication, about 70% of patients were able to successfully stay off the medication. And about two-thirds of those patients had actually tried before, and they were looking at some of the hardest medications to get off, like Effexor and Paxil.
Kristin Myers: So I want to ask, because, you know, Dr. Horowitz, your co-founder, is obviously very heavy in the research, has built out the clinical guidelines that your company is built on. But how do you kind of keep some of those lines separate between running this business, right, and where the medicine and where the science sort of goes? Because it sounds like sometimes that might possibly come into opposition with each other.
Brandon Goode: Honestly, you know, when the insight for Outro first hit me, it was after talking to a patient at my former company. I kind of sat back in my chair and it all came together. I was like, this is the best idea I’ve ever thought of, because the science aligns, the truth and good for humanity aligns, and the business model aligns.
And that’s a through line that I’ve always had while building Outro, is I have to be imaginative enough and creative enough that I keep a strong business model, or even strengthen the business model, around the science, not fit the science or the clinical outcomes to the business model, right? And that’s, you know, Mark has helped me hold a high standard there. I think I hold myself to a high standard there, but that’s what we’ve been able to do.
Kristin Myers: So I want to dive a little bit more into this, but I’m really curious to know, because we started this conversation on antidepressants and all the stats that we’ve been telling folks have been about antidepressants. But as you were mentioning at the start of the program, there’s a lot of medications that people need help tapering off of. So as you guys are thinking about expanding, are you thinking about adding on other medications to help people taper off of, or are you strictly focused on antidepressants for right now, as you build out the business from those 14 states, I’m assuming, eventually maybe to all 50?
Brandon Goode: Yeah. I mean, antidepressants are the wedge. They’re a massive wedge, as you can see by the numbers. They’re a great place to start. It’s where my co-founder really made his name. It’s a very poignant conversation in the culture right now.
Our next foray next year is broadening to the majority of psychiatric medication classes. So my co-founder’s textbook covers benzodiazepines like Xanax, sleep drugs like Ambien, gabapentin as well. So gabapentin is, depending on the stat you look at, the fifth or eighth most prescribed drug in America now. And England is starting to flag alarm bells on the overprescription and the problems of getting off it.
And then looking even broader, you know, hyperbolic tapering is based off this chemical law called the law of mass action. And so it applies basically to all chronic drugs. My co-founder’s published on opiates as well, like Suboxone. And I even found a paper from December of last year that showed that same hyperbolic curve in the response to GLP-1s. So that’ll be my victory lap. Full circle.
Kristin Myers: Full circle moment.
Brandon Goode: Yeah.
Kristin Myers: Okay. So I want to talk, going back to sort of the antidepressants now. One of your advisors founded this online community. It’s called Surviving Antidepressants. It’s an online withdrawal community, and it’s a bunch of forums that help a lot of folks that are trying to essentially taper off of these medications.
Now, some of them kind of step into the realm of believing that, you know, psychiatric medicine is actually frequently or often always harmful. So how do you kind of stay on this sort of line, right, between having that medicine or seeking out that sort of medical treatment, because there is still so much stigma around mental health and getting treatment for it, and also helping folks get off of those same medications?
Brandon Goode: 100%. So yeah, that’s Adele Framer. And I’d like to shout out all the people who have done this work after being neglected by a system that’s long not believed in these issues.
For me, one of my guiding principles is trusting in the truth and trusting and empowering people with information. So, you know, in medicine, they talk a lot about risks and benefits. So I try as much as possible, and I try to make sure Outro as much as possible provides everyone with the risks and benefits of starting medications, staying on medications, getting off medications. And I trust that Outro will be a successful business the more people have that truth, right, the more people have that science and understanding. So that’s really how I approach it. And I don’t try to apply any type of judgment to the decision that somebody makes. I just hope to be able to empower them with the right information.
Kristin Myers: Speaking about the right information, there’s a lot of politics lately around this. RFK Jr., secretary of health, has said a lot about medication and has said that coming off of these drugs can be as hard as coming off of heroin. A lot of scientists dispute that. A lot of scientists dispute, frankly, a lot of the claims that RFK Jr. has made. I’m curious to know if the political environment that we’re in right now has made your job and scaling this business harder or easier.
Brandon Goode: You know, as a founder, I try to make lemonade out of lemons, right? And there’s ways that, we just have to be careful and thoughtful. We don’t want to try and just jump on a moment and say things that we don’t believe are true for short-term gains, right? We’re in this for systemic change in the long haul and the improvement of society, of mental health care and healthcare in general.
And so I try to stick by the science. And, you know, I suggest people look up, there’s some interesting data from the FDA adverse events reporting that there’s a few antidepressants, Cymbalta specifically, Paxil and Effexor, that actually rank amongst opioids for the frequency of reported withdrawal symptoms. So I’m not going to say I agree or disagree with the statements, but that’s a very interesting paper. And there are a lot of people, you know, who have had extremely horrendous times getting off these drugs, who say it’s been harder than them breaking an opioid addiction in the past. And, you know, I think everybody should be heard and have their experiences validated and supported.
Kristin Myers: Okay. I’m going to try to get through these last two questions with you in one minute. Is there a patient that you would turn away from the platform?
Brandon Goode: Yeah. It mainly has to do with their safety. It tends to be, rather than them not being appropriate to try and get off their medications, it’s more they’re not appropriate for a virtual care service. They might need some additional supports.
Kristin Myers: Right. So this is a question that I ask every single founder that sits next to me on the floor of the stock exchange. The big bell is right over there behind us. Do you ever think about scaling to a point that you go public? As a founder, what do you think about when you think about that? And when do you think something like that might happen, taking Outro to the public market?
Brandon Goode: Yeah, I might sound corny, but the biggest thing I think about is fundamentally changing the world and the way society operates or views something very fundamentally important, at its grandest scale possible. And I’ve chosen this problem because I genuinely think it’s one of the most important problems in the world. And the breadth of this problem is so massive that I think it warrants it growing into being a public company. And, you know, I’m in it. I’m in it for the long haul. Hopefully in the next decade we’ll get there.
Kristin Myers: That’s not corny at all. A lot of founders have the same passion that you do as well for what they’re building. Brandon Goode, co-founder and CEO of Outro, thank you so much for joining us today.
