Say a coworker mentions ketamine therapy for depression. You read about it for an hour that night, then do what almost everyone does with a medical question: you decide to raise it at your next appointment.
That instinct is close to universal. We paid Pollfish to ask 443 adults, spread over ten Midwest states with Missouri among them, whose recommendation would push them toward ketamine-type care for depression or post-traumatic stress. Seventy-four percent named their own doctor, and 2 percent named an ad.
The finding in plain terms
The full spread was lopsided in a way survey results rarely are. Beside the 74 percent who chose their own physician, 18 percent picked a close friend or relative, 4 percent someone in uniform whom they follow online, 2 percent advertising, and 1 percent a podcast host.
A second question pointed the same way. When asked about a first stop, respondents leaned on primary care (56 percent), then psychiatry and other mental health care (23 percent); 12 percent would research alone, 1 percent would consult a friend, and 5 percent confessed they had no starting point.
These figures are final, after the panel's quality checks.
Why the distance between 74 and 2 is so wide
Advertising can tell you a treatment exists. It cannot tell you whether it belongs anywhere near your history, your other prescriptions, or your insurance card, the questions that stand between curiosity and a scheduled appointment. Only someone with your chart in front of them can answer those.
The second reason is less flattering to the category. Ketamine's reputation arrived long before its clinical use did, and a treatment with that baggage needs someone trusted to vouch for it. An ad cannot vouch. A physician can.
Most people have never heard of the version the FDA approved
This part surprises St. Louis readers. Spravato, an esketamine nasal spray the FDA cleared for treatment-resistant depression, was unfamiliar to 73 percent of respondents. Another fifth of the sample, 21 percent, recognized just the name, and 6 percent knew what the drug is.
So if you feel behind on this topic, you are in the large majority. And hold onto the distinction casual conversation loses: esketamine, sold as Spravato, has FDA approval and is dispensed only for supervised use in certified treatment settings, while ketamine mailed out by online services is a different arrangement with a different level of oversight. The two are talked about as one thing. They are not. If you want to see the supervised version described by a clinic that provides it, Brain Recovery Centers keeps a Spravato treatment overview.
What people actually type when they go looking
In one free-text question, respondents wrote down the search they would run during a hard stretch. Of the 319 who answered, almost none typed a drug name. They wrote "someone please help me," "therapist near me," and "how to cope with my anxiety."
People search in symptoms and in sentences that sound like asking for a hand. The conversation does not start with a molecule. It starts with a bad stretch that has lasted too long.
What this suggests for someone in the St. Louis area
If your doctor is the deciding voice, make that conversation easy to have instead of waiting for it to happen.
- Book the visit for this reason specifically. A depression conversation squeezed into the last four minutes of a physical rarely goes anywhere, so ask for a longer or behavioral health slot.
- Bring your history in writing: every antidepressant, a rough dose, the months you stayed on it, and what made you quit. Treatment resistance is a specific clinical idea, and your record is the evidence for it.
- Ask directly whether you meet the criteria for esketamine, and if your doctor is unsure, whom in the region they would refer you to.
- Ask what your plan requires before anything is scheduled. Prior authorization, a documented count of earlier medication trials, and network status are all settled before a first visit, not after.
A no deserves a reason, and the reason may be good. A psychiatrist's second opinion is a normal next step, not a betrayal of your primary care relationship.
The two things that decide it for most people
Once someone is open to the idea, two factors carry the outcome. Coverage comes first; 85 percent of respondents counted it among their two top provider considerations, far ahead of nearness (43), FDA approval (27), speed (24), privacy (11), and practices specializing in veterans and first responders (10). For 65 percent, insurance could make or break the choice to pursue treatment at all.
Regulatory standing is second. FDA approval weighed decisively or heavily for 59 percent, the practical argument for knowing which version you are being offered before you hand over a credit card.
We also offered a straight tradeoff between insured care with more hoops and paying to start sooner. Half took the hoops, and the rest split, 23 percent paying to keep it simple and 26 percent unsure. Half this sample will accept real administrative friction to stay covered.
One thing this article is not
This is market research about how adults decide where to seek care, not clinical evidence, and nothing here recommends for or against any treatment. Whether esketamine or anything else fits you depends on your diagnosis, medication history, and conditions, which is a clinician's judgment.
Above all of this, one point. If the weight has ever turned into thoughts of ending your life, tell someone today. Text or call 988 for the Lifeline, free and at any hour, and a person will answer; no appointment is required.
Methodology
This site's publisher commissioned and paid for the survey, which Pollfish carried to its consumer panel; fieldwork stopped June 23, 2026. The 443 consenting adults in the finished sample were 18 through 64, lived in ten Midwest states, and came from the general population, not a screened patient group. Multi-answer results are percentages of respondents, so some lists add past 100. All figures are final and validated.