From our survey

What the 72 percent finding does and does not mean, for referrers

When we share one particular number from our survey with clinicians, the reaction is usually the same: a pause, then "That seems high." It is high. It is also easy to misread in both directions. This FAQ is meant for Midwest clinicians who refer, primary care first among them, and who want to know exactly what the finding says, what it does not say, and whether it should change anything in practice.

What is the finding?

Of 443 Midwest adults we surveyed, 72 percent described depression, anxiety, or PTSD left unrelieved by standard medication, either in their own life or in someone close. The answer options broke down as follows: themselves only, 37 percent; someone close only, 22 percent; both, 13 percent; neither, 28 percent.

Who ran the survey, and when?

We did, as publisher, and we paid for it. Pollfish ran it among its panel of consumers and stopped collecting on June 23, 2026, with adults 18 to 64 from Ohio, Illinois, Minnesota, Missouri, Kansas, Iowa, Indiana, Oklahoma, Nebraska, or Wisconsin. The figures are final, taken from the panel after validation.

Is 72 percent the prevalence of treatment-resistant depression?

No, and it should not be quoted that way. Several features of the question push the number above any clinical prevalence estimate:

• It included anxiety and PTSD, not only major depression.
• It counted people who reported the experience in someone close to them.
• "Did not help" was the respondent's own judgment, with no check on dose, duration, or adherence.
• The sample came from a consumer panel and was not weighted to population benchmarks.

What the figure measures is lived experience: how many people believe that standard medication fell short for themselves or someone they care about.

Then why should a clinician care?

Because belief drives behavior. A patient who thinks their medication failed may quietly stop taking it, stop coming in, or keep going without telling you it is not working. The finding suggests that a large share of adults carry that belief. Summing the "themselves" and "both" answers, 50 percent reported it as their own experience.

If even a portion of that shows up in your panel as unrecognized partial response, a more deliberate check on response at follow-up visits is worth the minutes.

Can you tell me how Medicaid patients, or veterans, or older adults answered?

Not in this FAQ. The final validated data does include some group breakdowns, but this piece sticks to whole-sample figures. One group cannot be broken out at all: people who have served or respond themselves, a head count of 29, a number too thin to report on its own. Anyone quoting a figure for that group is quoting a number the survey cannot support. The overall payer mix was close: a commercial plan for 39 percent, Medicaid for 37, Medicare for 23.

What else did the survey find that bears on referral?

Three things stand out.

First, awareness of later-line options is very low. Spravato, an esketamine product delivered by nasal spray and approved for adults with treatment-resistant depression, was unknown to 73 percent, and just 6 percent knew what it was. Roughly one in four knew what TMS was. For patients who ask, this plain Spravato overview is a reasonable handout.

Second, patients defer to their physician. For three quarters, a push from their own doctor is what it would take to try a new treatment. More than half would go to primary care first.

Third, coverage and proximity dominate choice. When weighing providers, 85 percent of respondents kept insurance in their top two, and proximity for 43 percent.

Does this mean I should refer more patients for esketamine?

Not as a blanket rule. Esketamine is appropriate for some adults with treatment-resistant depression, delivered at a certified center that watches the patient after each dose and a ride home required. It is not appropriate for everyone, and it is not approved for PTSD or anxiety disorders. The practical takeaway is to make sure the conversation about next options happens, and that esketamine is part of it where clinically reasonable. The decision belongs with you and the patient.

What about patients who ask about at-home ketamine?

Expect the question. Patients often do not distinguish between esketamine and off-label ketamine, whether infused at a clinic or prescribed for home use. A short, neutral explanation helps: one is FDA-approved and supervised in a certified setting, the other is off-label and, when used at home, carries much less monitoring.

Were patients open to these treatments?

Mostly cautious rather than closed. Cautious but open was the first reaction of a third of respondents to ketamine therapy for depression or PTSD; hopeful or curious drew 18 percent, skeptical 21 percent, and negative 9 percent. Because FDA approval was deciding or big for 59 percent, the esketamine versus ketamine distinction matters in conversation.

Why publish a number you warn people not to over-read?

Because the alternative is worse. A striking figure left unexplained tends to get quoted loosely, stripped of its caveats, and turned into a claim the data never made. Publishing it with the question wording, the answer breakdown, and the limits spelled out gives clinicians a way to use it honestly. It is a signal about how many people feel let down by standard treatment, not a verdict on how often that treatment fails.

What is the simplest practice change this supports?

Ask about response explicitly at every follow-up, document each medication trial clearly, and name treatment-resistant depression to the patient once it applies. Those three habits make everything downstream, from referral to prior authorization, easier.

Can I cite this survey?

Yes, with context. Cite it as a final, publisher-commissioned Pollfish consumer panel survey of 443 Midwest adults, closed June 2026, and describe the 72 percent as self-reported personal or close experience with standard medication falling short against depression, anxiety, or PTSD. Do not cite it as a prevalence estimate or a clinical outcome.

For patients at risk between visits, the Suicide and Crisis Lifeline answers 988 nationwide, by phone or text, at all hours, and veterans can press 1. It is worth printing on every depression care plan you hand out.

Methodology

Pollfish consumer panel; 443 completed questionnaires; fieldwork ended June 23, 2026; respondents 18 to 64 from the ten states named above. Top-line percentages only in this piece. Multi-select questions total more than the sample. Final, validated panel data. Commissioned and paid for by the publisher. Not clinical guidance.