Ariella Sharf was first prescribed antidepressants when she was a college student more than a decade ago. When she decided to stop taking them last year, Sharf says she wasn’t sure how to do it safely. She was disappointed when her longtime psychiatrist didn’t help her find a new doctor after she moved across the country, and she thought her primary care physician wasn’t equipped for the task. Sharf decided instead to try Outro Health, a telehealth startup that CEO and cofounder Brandon Goode describes as “Uber for getting off antidepressants.”
Outro officially launched in the US last month and is currently available in seven states, including California and New York. The startup is betting that many of the growing number of Americans taking antidepressants will eventually want help coming off them. Over 11 percent of US adults took medication for depression in 2023, according to the US Centers for Disease Control and Prevention’s National Health Interview Survey, which found women were more than twice as likely as men to use the drugs.
About one in six people who stop taking antidepressants experience side effects like nausea and dizziness, especially if they do so abruptly, according to one study. Other research has found the prevalence of adverse withdrawal symptoms may be much higher, particularly among patients who have been on them for long periods.
For a monthly fee starting at $125, Outro pairs patients with a clinician who meets with them on a custom schedule—often weekly or monthly—and guides them through a tailored tapering program. Outro currently employs a small group of medical contractors, including nurse practitioners specializing in psychiatry and general nurse practitioners, who are supervised by psychiatrists. For now, patients pay for the service entirely out of pocket, but Goode says Outro plans to start accepting insurance soon.
Outro’s program is currently focused specifically on drugs often prescribed for depression, including selective serotonin reuptake inhibitors (SSRIs) like Lexapro and Prozac, and serotonin–norepinephrine reuptake inhibitors (SNRIs) like Pristiq and Cymbalta. In the next year, Goode says, the company is planning to expand beyond antidepressants and begin offering tapering programs for stimulants and benzodiazepines, two classes of drug that are commonly prescribed in the US for issues like anxiety and ADHD and are known to cause intense withdrawal symptoms.
“I was kind of waiting for something like Outro to exist,” says Sharf, who became one of the company’s first patients in the United States last June as part of a pilot program in California. “Everything was tailored around how I wanted to do it.” Twelve months later, Sharf says she is still tapering off her medication with help from Outro at a pace that works for her.
When customers sign up for Outro and get matched with clinicians, they then typically follow a tapering method endorsed by one of Outro’s other cofounders, the British academic psychiatrist Mark Horowitz. Known as “hyperbolic tapering,” it’s a substantially more drawn-out process than other methods used to help people get off meds.
Unlike a linear taper, which involves reducing the dose of a medication by the same amount each time, a hyperbolic taper gradually slows the rate of reduction—cutting smaller and smaller amounts as it goes—so that the final doses are extremely small and spread out over a much longer period. To facilitate this, Outro partners with compounding pharmacies to produce custom versions of generic antidepressants in minuscule doses that are not available commercially. In other words, while Outro promotes itself as a service for getting off medication, part of its business model hinges on people continuing to take the compounded drugs its clinicians prescribe.
Horowitz, who has become one of the UK’s leading experts on medication tapering, known as de-prescribing, says his interest in the topic was driven by his own harrowing experience coming off antidepressants more than a decade ago when he was a psychiatry doctoral student. Horowitz crafted a gradual tapering plan for himself that involved using syringes from his research lab to dole out small liquid doses of escitalopram, known by the brand name Lexapro. But he couldn’t prevent the misery induced by discontinuing the drug.
“My life exploded,” Horowitz says. His symptoms, which included severe insomnia and dizziness, were so debilitating that he moved back in with his parents. “It took me years to come off, not weeks as guidelines recommended.”
After he recovered, Horowitz began pushing for doctors to adopt new clinical guidelines for getting off antidepressants. He coauthored the Royal College of Psychiatry’s guidance for psychiatric drug cessation and joined the UK’s National Health Service as a clinical research fellow. His goal with Outro is to bring the guided tapering methods he has developed to a new patient base in North America.
Goode, Outro’s CEO, has a background working in pharmaceuticals and telehealth that includes stints at Novo Nordisk and the psychedelic therapy startup Field Trip Health, now known as Stella. “People kept asking how to use psychedelics to get off antidepressants,” Goode says, which led him to suspect there might be a substantial swath of the population who wanted help quitting the drugs.
Horowitz and Goode cofounded Outro in 2022 along with another Field Trip alum, Tyler Dyck. The company’s small team also includes Adele Framer, the founder of Surviving Antidepressants, a long-running forum where people swap tips on how to taper off this class of medication.
It’s a fraught moment to be launching a health startup in the US focused on getting people off psychiatric drugs. The US secretary of health and human services, Robert F. Kennedy Jr., has questioned whether the medications are overprescribed, and has made false claims linking antidepressants to school shootings and increased violence. Similar views have been articulated by other Trumpworld figures, including DOGE architect Elon Musk, who told Tucker Carlson that SSRIs are “the devil.”
Horowitz says he shares some of Kennedy’s concerns about whether antidepressants are overprescribed and how severe withdrawals can be. But he’s disturbed that Outro’s project could be seen as aligned with the health secretary’s broader Make America Healthy Again movement, especially as he considers himself “to the left of Bernie Sanders.”
“The fact that this has become a political football is really dangerous,” he says. “These medications have benefits—and they have harms, and can be difficult to stop. My work is about helping people navigate those things in an informed way.”
There is a small but growing group of mental health experts who say it’s time to reevaluate how antidepressant withdrawal is understood and treated. Anders Sørenson, a clinical psychologist in Denmark specializing in psychiatric de-prescribing, says the status quo for most patients is “not just inadequate, but often actively harmful.” He sees an urgent need for more doctors to craft hyperbolic tapering plans customized to each individual patient’s needs.
Some psychiatry experts push back on the idea that hyperbolic tapering programs are necessary for many patients. Jonathan E. Alpert, a psychiatrist and professor at Montefiore’s Albert Einstein College of Medicine, agrees that taking a thoughtful approach to tapering is important and says hyperbolic tapering “makes some sense neurobiologically.” But he thinks a large portion of people who want to quit psychiatric drugs can do so by using what he considers to be “less fussy” methods, like gradually halving doses, rather than relying on “an extremely precise, extremely elaborate and potentially resource-intensive approach to a problem that usually can be handled in a much more straightforward way.”
Horowitz sees his work with Outro as part of a larger mission to shift the public conversation about the root causes of psychological problems. While he doesn’t want to discourage people who need medication from taking it, he believes that the level of chronic SSRI use happening today should be carefully evaluated to ensure social factors contributing to mental health issues are not being overlooked. “To me, it is actually a very leftist issue to de-medicalize the way we treat anxiety and depression,” he says, noting that such illnesses are often caused “by social circumstances, by poverty, by loneliness.”
Outro is making the opposite pitch of most online health startups, offering to help people stop drugs rather than start them. But its website doesn’t look too different from that of other telehealth companies, featuring the same neutral colors and clean fonts that have come to define the world of direct-to-consumer millennial wellness brands. On its landing page, a chirpy pop-up appears advertising its introductory offer: “Get started for $99.”
