Australian Financial Review
Former trade minister Andrew Robb will advise a Geelong start-up that's invented a genetic guide to antidepressant drug dosage, in the mental health advocate's first corporate role since retiring from politics at the recent federal election.
CNSDose, founded at University of Melbourne's MAP accelerator last year by alumni Ajeet Singh, has just raised $1 million and in January inked a distribution deal with a US-wide chain of DNA testing labs, AlphaGenomix.
Now Mr Robb, inspired by his own experience battling depression, is helping the start-up make connections with pathology lab chains in China, Hong Kong and the US, based on his own networks.
Dr Singh has been working towards the start-up since he began practicing psychiatry in 2005.
"After about a year it was clear that the prescribing of antidepressants was all based on trial and error," Dr Singh said.
"Some patients were getting under-dosed and not feeling any better, others were taking a whole pill where they should have been prescribed one-quarter, and then they were getting blamed for the anxiety-causing side effects."
By 2006, some research had been done on how liver enzyme genetics might influence the correct dosage for an individual.
"When you swallow a pill, your liver considers it a poison and knocks most of it out, but your genetics will determine how much," Dr Singh said.
But he realised virtually no research had been done on the genetics behind the blood-brain barrier, another filtration system for chemicals trying to reach the brain.
By early 2015 Dr Singh had come up with a combination of gene variants he believed could guide antidepressant prescriptions.
Dr Singh bankrolled his own 12-week, randomised, controlled-trial and found a remission of depression symptoms in 72 per cent of patients with genetically-guided dosing, versus 28 per cent for those with unguided dosing.
With an international patent pending on his gene combination, Dr Singh entered two start-up contests last year – MedTech's Got Talent and Geelong IT Invention Test. He won the latter and met two co-founders – chief medical officer Harris Eyre (a 27-year-old doctor and Fulbright scholar) and marketer Campbell Walshe.
Accepted to the MAP Accelerator, CSNDose attracted the attention of University of Melbourne Professor Emeritus John Tiller, a renowned pyschiatrist who in turn helped convince one of his patients – Andrew Robb – to join him on the startup's advisory board.
"The story hit the spot for me, because the six months I spent changing antidepressants and dosages every four weeks were the worst of my life," Mr Robb told The Australian Financial Review, while speaking of the 2009 period where he stepped back from the then-Opposition frontbench.
"I did eventually get to [a point] where I've had the best six years since I was 12-years-old, but the problem is very few persist as long as I did."
Getting it right
According to Dr Tiller, about 70 per cent of those requiring a pharmacological solution for their depression don't get prescribed the right antidepressant straight away, and give them up within four weeks.
"The side-effects can be terrible, so many feel they're poisoning their body for no benefit and don't even get past the first iteration of trial-and-error. The problem is they then stay depressed," Mr Robb said.
CNSDose's algorithm recommends antidepressant types and dosages based on DNA-testing of a mailed-in saliva sample. A general practitioner can then simply fill out a prescription based on the report, which in the US will cost between $US300 and $US400 when the first sales through AlpaGenomix are made later this year, according to Dr Singh.
"If people see depression can often be effectively treated within a GP-patient relationship, more will come forward and raise the subject," Mr Robb said.
"We're short 600 psychiatrists in Australia anyway, so if we can remove the stigma some people associate with seeing one, we can do a lot of good."
Mr Robb is working on a pro bono basis in return for future equity, according to Dr Singh, who continues to juggle CSNDose with treating patients at his Geelong clinic.