Every treatment plan hides a second schedule. It belongs to whoever drives, waits, watches, and remembers. If you are caring for someone in St. Louis who is weighing ketamine or esketamine therapy, that second schedule is probably yours.
What follows explains the three ways this care is delivered and what each asks of the people around the patient. It recommends none of them. Which fits, if any, is for the clinician treating the person you love.
What people told us they want
Our commissioned survey asked 443 adults, spread from Illinois and Missouri across eight more Midwest states, how they would prefer to get this kind of treatment. The in-person clinic topped the list at 44 percent. Home telehealth claimed 22 percent, and a plan that starts in the clinic and shifts home claimed 23, while 11 percent did not mind which.
Add the two clinic camps and you get 67 percent of respondents who want a clinic in the mix somewhere, which means a lot of trips across the metro. These are final numbers, and it is worth knowing what each option really requires before the family commits.
Model one: supervised treatment at a certified site
This is how esketamine, sold as Spravato, is given. Its FDA approval, for depression that standard antidepressants did not relieve, comes with rules about setting. The patient uses the spray at a certified site under a provider's supervision, is observed for a minimum of two hours afterward, and may not drive until the following day. For the patient's-eye view, Brain Recovery Centers explains what a Spravato visit looks like.
For the family, that means:
- A ride home every time. Many sites want to know in advance who is collecting the patient; ask whether a rideshare is allowed or a named adult is required.
- A block of time. Check-in, dose, and monitoring can take most of a morning or afternoon, before you add the drive from Florissant, Kirkwood, or the Illinois side.
- A front-loaded calendar. Visits tend to cluster early and thin out later if the clinician continues treatment.
Families often find it reassuring that a trained person is present during the stretch when dissociation or a blood pressure rise is most likely. Your job is logistics, not monitoring.
Model two: at-home telehealth ketamine
Here a prescriber meets the patient by video and prescribes ketamine, usually a lozenge or tablet, to take at home. It is not the approved product and not esketamine; it is generic ketamine used off label, and the least supervised of the three.
The logistics look lighter at first: no drive, no waiting room. But the work moves rather than vanishes.
- Some programs want another person present in the home during a session, and that person is often you.
- You become the one watching how the patient responds, without training and without backup.
- The medication lives in the house, which matters if there are teenagers, visitors, or a history of substance use.
Ask the program exactly what it expects from the household and what happens if something feels wrong mid-session.
Model three: clinic first, home later
Here treatment begins in a clinic and some part of care later moves closer to home. What "later" and "home" mean varies by provider, so press for specifics. With the approved spray, dosing stays in a certified setting throughout; the home part may mean follow-ups, therapy, or video check-ins, not the dose.
For caregivers, the hybrid usually means an intense first stretch of driving and waiting, then a lighter load. Ask when the shift usually happens and what has to be true first.
Why the location question is also a money question
Families rarely pick a model on logistics alone. Among our respondents, insurance appeared in the top two provider priorities 85 percent of the time; nearness to home was next at 43 percent.
The two interact. The supervised, approved treatment is the one most likely to fit a health plan's rules, often with prior authorization and records of earlier medication trials, while the at-home route is more often self-paid. Call the insurer before comparing drive times.
The payer mix shows how varied that call can be. Respondents could select several, and 39 percent named a commercial plan, 37 percent Medicaid, and 23 percent Medicare. In Missouri, Medicaid means MO HealthNet; across the river, Illinois rules apply.
Keeping the three straight
Most people have never heard of the approved option. In our sample, 73 percent could not place Spravato at all, so a family can easily hear "ketamine" from a friend, see an at-home ad, and assume it matches what a psychiatrist has in mind. It does not. When a provider describes a plan, ask, "Which of the three models is this?"
What a caregiver can prepare now
- A list of every antidepressant the person has tried, with rough dates and why each stopped. Clinicians and insurers both ask.
- A realistic ride plan for the first month if a clinic model is chosen.
- A conversation with your own employer about time off, if you will drive.
- Your own support. Caring for someone whose depression has not lifted with treatment is draining, and you count too.
Nothing here is medical advice, and no model of care is being recommended for your family. That decision belongs to the person you care for and their clinician.
Should the person in your care talk about wanting to die, or should their safety start to worry you, call or text 988. Lifeline counselors answer at every hour, nationwide, and they will talk with a worried relative as readily as with someone in crisis. If there is immediate danger, call 911.
Methodology
Pollfish study 395586438 was commissioned and funded by this publisher and fielded among members of the Pollfish consumer panel; its last day in the field was June 23, 2026. Every one of the 443 respondents was between 18 and 64 and lived in one of ten Midwest states. This article reports no St. Louis or caregiver breakdown, only top-line percentages. Where several answers were allowed, shares can top 100. Every result reflects the panel's final validation.