You came in expecting a dose change. Instead, your doctor says the word "esketamine." Maybe you have heard of it, maybe not. Either way, you feel the familiar tightening of doubt. You are not ready to say yes. You are not sure how to say no. And you do not want to leave with nothing.
This script is for St. Louis area patients in exactly that spot. It helps you test the recommendation with clear questions, especially about FDA status, without turning the visit into an argument.
A little context first
Doubt about ketamine therapy ran through the summer poll we funded, 443 adults from Missouri and nine nearby states: 21 percent reacted with skepticism and 9 percent negatively. FDA approval, meanwhile, weighed on most, with 59 percent of respondents calling it big or deciding.
Spravato is the brand name of esketamine, and its FDA approval covers treatment-resistant depression. But most people do not know that; in our poll, Spravato was a brand new word to 73 percent. So it is completely normal to hear the name for the first time in an exam room.
The poll numbers are final; treat this script as general information rather than medical advice.
Step 1: Buy yourself a moment
You do not need to respond immediately. Try:
"Okay. I'm going to be honest, I'm skeptical of anything with ketamine in it. Can you walk me through why you're suggesting this for me?"
This does two things. It tells your doctor where you stand, and it invites them to explain their reasoning instead of just the treatment.
Step 2: Pin down exactly what is being suggested
"When you say esketamine, do you mean Spravato, the nasal spray given at a certified clinic? Or another form of ketamine?"
This matters because "ketamine" can mean three different things in the St. Louis market. Spravato holds the FDA approval, for depression that resists treatment, and every dose is watched by staff at a certified site. Infusion clinics use IV ketamine off-label. Telehealth ketamine for home use is off-label as well, and sometimes compounded. Your doubts may land differently on each.
Step 3: Ask about the approval
"What exactly is it approved for? Is my situation on-label?"
If your depression has not improved after trying antidepressants, your doctor may explain that this is the approved use. If the suggestion is for something else, such as PTSD or anxiety, you can follow up:
"So that would be off-label? What's the evidence for using it that way, and is there an approved option we should try first?"
Step 4: Ask about the safeguards
"I've heard it has to be given at a special clinic. What happens during a visit?"
Your doctor should explain that Spravato comes with a required safety program. You use the spray while a nurse watches, stay two or more hours afterward, and hand off the driving until tomorrow. Brain Recovery Centers has a page describing a typical Spravato treatment day if you want to read ahead. Knowing this helps you judge both the risk and the commitment.
Step 5: Ask about what worries you most
Name your concern directly. Some ways to put it:
"My biggest worry is the reputation ketamine has. How is this different?"
"I'm worried about feeling out of control. What does the dissociation feel like, and how long does it last?"
"Could I get dependent on it?"
The label lists sedation, dissociation, raised blood pressure, and potential for misuse among the risks, which is part of why the safety program exists. A good doctor will answer frankly.
Step 6: Ask what else is on the table
"Before I decide, what are the alternatives? Is there anything that doesn't involve a new medication?"
Your doctor may mention psychotherapy, or TMS, a drug-free scalp-coil treatment with FDA clearance for adults still depressed after antidepressants. Respondents in our poll wanted a drug-free option at 64 percent, but about a quarter had heard of TMS. It is worth asking.
Step 7: Ask the St. Louis logistics questions
"Where's the nearest certified site to where I live? And does my insurance cover it?"
These questions matter as much as the clinical ones. Our respondents ranked coverage first, 85 percent placing it among their two main priorities, with a nearby location next at 43 percent. MO HealthNet members can have the office check esketamine coverage and in-network certified sites. From the Metro East, ask whether your Illinois plan counts a Missouri site as in network.
And plan for the ride: no driving after a dose means a friend or relative behind the wheel every time.
Step 8: Leave the door open without committing
"Thank you. I'm not ready to decide today. Can you write down the name and the nearest site, and can we talk again after I've looked into it?"
That is a complete, respectable answer that buys you time to check the facts.
A few ground rules
- Keep taking your current medication while you decide, unless your prescriber tells you otherwise.
- Bring a friend or family member next time if it helps. In our survey, they were the second most trusted source after a patient's own doctor, named by 18 percent.
- Remember that whether esketamine or anything else suits you is a clinical question that depends on your history.
Why ask your doctor at all?
Because most people trust their doctor more than anyone else on this. In our poll, 74 percent would follow a trusted physician into a new treatment, compared with 2 percent who would follow an ad. Being skeptical in that conversation is not disrespect. It is how you and your doctor reach a decision you can both stand behind.
Suicidal thoughts should not sit until the follow-up appointment. In St. Louis or anywhere else, dialing or texting 988 puts you through to a Suicide and Crisis Lifeline counselor, all day and all night.
Methodology
We fielded Pollfish survey 395586438 with its consumer panel until June 23, 2026. The 443 people who finished it were working-age adults from Missouri, Oklahoma, Illinois, Minnesota, Kansas, Indiana, Wisconsin, Iowa, Ohio and Nebraska, and each consented at a screener before starting. We report the validated whole-sample numbers. Commissioning and funding came from the publisher.