From our survey

Where depression treatment can happen: a Midwest veteran FAQ

Veterans across the Midwest ask a version of the same thing once they start looking into newer depression care: not "does it work," which no honest source can promise, but "where would I have to go, how often, and can I fit it into my life?" This FAQ takes those questions one at a time.

Where survey figures appear, they trace back to a June poll that our publisher funded and that 443 adults from ten Midwest states completed. Respondents were members of the general public rather than veterans alone, so every percentage reflects the whole group. They are the survey's final, validated numbers.

Would I get treated at a clinic, at home, or both?

It depends on the treatment. Therapy and medication check-ins can happen either way. Esketamine, the FDA-approved nasal spray sold as Spravato, is clinic only, every dose. At-home ketamine sold through telehealth companies is a separate, off-label product taken without a clinician present.

If you are curious what other people would choose, the survey found the local clinic was the favorite at 44 percent. One in five, 22 percent, would rather do it all from home. Slightly more, 23 percent, would prefer a clinic at the start and home afterward. The remaining 11 percent had no opinion. Taken together, roughly two-thirds, 67 percent combined, wanted in-person care at some stage.

What is Spravato approved for, exactly?

Treatment-resistant depression in adults, meaning depression that has not improved enough with standard antidepressants. A second approval, used together with an oral antidepressant, covers adults whose major depressive episode includes acute suicidal thoughts or actions. PTSD, anxiety disorders, and other conditions are outside its label.

Where would I find a certified site?

Ask the psychiatrist who evaluates you, or call your insurer and ask for in-network sites that administer esketamine. Before booking, confirm the site accepts your coverage and ask how early and how late it schedules patients.

What if the nearest site is hours away?

Distance is a fact of life for veterans in western Kansas, the Nebraska Sandhills, northern Minnesota, and the rural counties of Iowa, Missouri, and Illinois. A few options to raise with your clinician:

• A hybrid plan. Evaluation and any supervised treatment in person, with routine follow-ups by video.
• Telehealth psychiatry. Many psychiatrists handle evaluations and medication management by video, so the only trips are the ones that truly require a clinic.
• A closer site in the same network. Ask your insurer whether another certified location is nearer than the first one you were given.

People care a great deal about proximity. Being near home was the runner-up priority in the survey, chosen by 43 percent.

How long does a clinic visit take? Can I drive myself?

A Spravato session is the dose plus roughly two hours of monitoring, since the drug can bring on dizziness, dissociation, sedation, and higher blood pressure. Driving yourself home is not allowed. Per the label, driving and heavy machinery wait until the day after, following a real night's sleep. Line up a ride before your first visit. Brain Recovery Centers explains how Spravato appointments are run if you want more detail.

Visits come thick in the early weeks and thin out later. Your prescriber sets the schedule.

Can a spouse or family member come with me?

Usually yes, at least to the clinic and often into the waiting area. Many clinics are glad to have a family member present for the intake conversation, if you want that. Ask when you book. If you would rather go alone, that is your call; you just still need someone to drive.

Does TRICARE cover it?

TRICARE covers many medications with prior authorization, and esketamine coverage decisions depend on your plan and your history. Call TRICARE or check your plan documents, and ask whether the clinic you are considering is a TRICARE-authorized provider.

In the survey's payer question, which allowed more than one answer, TRICARE was the coverage for 5 percent of respondents. Commercial insurance led with 39 percent, Medicaid came close behind at 37 percent, and Medicare followed at 23 percent.

What about Medicare or my employer's plan?

Many plans cover esketamine with prior authorization, usually requiring documentation of prior antidepressant trials. Ring the plan using the number on your card, and ask three things: Is it covered? Is prior authorization needed? Which in-network certified sites are closest to me?

Insurance topped every factor in the survey. More than eight in ten respondents, 85 percent, listed it in their top two when choosing where to get care.

Is at-home ketamine a reasonable shortcut?

It is a different product with different risks, not a shortcut to the same thing. At-home ketamine is off-label generic ketamine, usually taken as a lozenge without supervision. The FDA has warned about potential risks when ketamine is used outside a medical setting. If you are considering it, bring the details to your own doctor first and ask how it would interact with your other medications and conditions.

Who should I talk to first?

Whoever knows you medically. The survey had 56 percent calling their primary doctor first, with 23 percent opting for a psychiatrist or other mental health provider. Only about 2 percent of the sample were veterans or active military, too few to break out even with first responders added, so those are general-public habits, but the logic holds for anyone.

No other influence came close to the physician's. When we asked what would tip someone into trying a new treatment, 74 percent pointed to a recommendation from the doctor they already see.

Should I treat this as medical advice?

No. It is background reading. No treatment in this category helps everyone, and whether it suits you should be settled with a clinician who has reviewed your background, including head injuries, blood pressure, and substance use.

If life has started to feel not worth living, please do not wait. Get in touch with 988 by call or text, then press 1 if you are a veteran. There is nothing to enroll in, and a loved one can call on your behalf.

Methodology

Our publisher commissioned this survey and funded it, and Pollfish carried out the fieldwork with its consumer panel, which quit taking answers on June 23, 2026, with n=443 people, all between 18 and 64, from Minnesota, Iowa, Missouri, Illinois, Wisconsin, Indiana, Ohio, Nebraska, Kansas, and Oklahoma. Veterans were part of a broad sample, not studied on their own, and every figure is final after Pollfish's validation.