Updated on 19 August 2016
Dr Ajeet B Singh, CEO and Founder of CNSDose
Singapore: WHO estimates that globally, nearly 350 million people suffer from depression. As explained by the health governing bodies, depression is a common illness worldwide and is different from mood fluctuations and short responses to daily challenges in life. Affecting more women than men, depression is considered as a major cause of disability, and a major contributor to global disease burden. When long-lasting and with moderate or severe intensity, depression may become a serious health condition and can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Over 800 000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds. The burden of depression and other mental health conditions is on the rise globally. A World Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated response to mental disorders at country level.
The major issue with battling depression is the stigma associated with it. Although there are known, effective treatments for depression, fewer than half of those affected in the world (in many countries, fewer than 10 percent) receive such treatments. Barriers to effective care include a lack of resources, lack of trained health care providers, and social stigma associated with mental disorders. Along with this, another major barrier to effective care is inaccurate assessment and in ability to decide the right dosage of medicine for a particular patient. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and not prescribed the correct dose of medication.
A group of young specialists from Australia have set out to resolve these challenges through their innovative start-up, CNS Dose that harnesses the power of genetics to tailor and customize dosages of anti depressant as per patient needs, to maximize the effect of medication and to minimize the errors. The CNSDose product was developed over the last 10 years by Associate Professor Dr Ajeet B Singh, a practicing psychiatrist and globally-recognised pharmacogenetics expert, CEO and Founder of CNSDose.
"After my first year in practice as a psychiatrist it was very apparent to me that much of the prescribing in psychiatry is on a trial and error basis," explained Dr Singh, "It takes nearly a month to judge if a medication is starting to work at a particular dose and patients can spend several months to years in a trial and error prescribing process. It's incredibly inefficient and delays recovery. Often patients get frustrated with the process and give up on care. Back in 2006 I had the idea that perhaps genetics may help reduce the trial and error prescribing. In 2012 I established a private company to develop an antidepressant guidance system. In 2015, I was joined by two co-founders - Mr Campbell Walshe MBA and Dr Harris Eyre MD PhD to progress the startup. Mr Campbell brings commercial development experience and Dr Eyre brings added medical and academic firepower to the team - being a Fulbright scholar at UCLA in 2015 and recently completing a neuroscience PhD. It's now very much a group effort."
CNS Dose's technology utilizes genomic testing to determine an individual's ability to metabolize antidepressants, thus improving the response to these drugs. Patients send a saliva sample and the technology analyzes various genetic variants of liver enzymes (involved in metabolising antidepressants) and genetic variants in the blood brain barrier. The results are then inputted by the lab into the CNSDose secure cloud server that generates a simple to understand medication guidance report for the doctor. The report stratifies 20 commonly used antidepressant into high, medium and low dose groups that help guide the doctor.
"The report has been shown to double recovery from depression compared to traditional trial and error prescribing in our clinical trial," Dr Singh, highlighted. "The finding was independently replicated by tenure-track academics - confirming the initial finding, with the method over 85 percent accurate. We have an Asian bespoke version of the test that includes gene variants more commonly found in Asian patients. All medication decisions are made by the treating doctor and the report is an added piece of information to support that decision making process."
Though the company currently has tested the technology only for depression, Dr Singh believes that the unique test should apply to a variety of brain disorders and other psychiatric medications, like epilepsy and dementia. Moving ahead the company is also planning to explore the test to other indications and focus on R&D to further enhance our technology and extent it's indication to other medication classes.
The company plans to start sales in the USA this October, with their US lab affiliate. Confident that their technology will create waves in the market, CNS Dose aims to expand rapidly and is keen to grow into Asia and conduct a clinical trial in Asia. "There is scope for CNSDose to be a platform technology. The leveraged business model of partnering with affiliated labs enables rapid global scaling, said Dr Singh, "I see CNSDose becoming a global leader in the space, driving R&D to move from the current ‘1 megapixel' camera stage to 10 megapixels of genomic resolution to help guide prescribing of Central Nervous System (CNS)medications. This is how the report got its name - CNSDose."