From our survey

What your recommendation means to Midwest patients, a referrer FAQ

Primary care physicians we talk with tend to ask the same handful of questions about esketamine referrals, usually in the last two minutes of a conversation, standing in a hallway. This is our attempt to answer them properly, using what 443 Midwest adults told us in a survey we commissioned this summer.

One caveat: these top-line results describe how people say they choose care, not clinical evidence.

Does my recommendation really change what a patient does?

Going by what respondents reported, it may be the single biggest factor. We asked which person's advice would most likely lead them to try ketamine or esketamine therapy, and almost three in four, 74 percent, chose their own doctor. Advice from someone close ranked second, picked by 18 percent, and everything else stayed in single digits: 4 percent for a public voice from the service or first responder community, 2 percent for an ad, and 1 percent for a podcast host.

Stated intentions are not behavior, but a gap that wide is hard to dismiss.

Won't the patient have heard about it already?

Probably not. Among respondents, the name Spravato had never registered with 73 percent, 21 percent had come across it without learning what it was, and just 6 percent could say what it is. Expect to explain the basics from scratch: esketamine comes as a nasal spray, its FDA approval is limited to treatment-resistant depression, and patients take it only under supervision at a certified site, never at home from a pharmacy bottle.

If I don't bring it up, where would they go instead?

We asked that directly. Primary care was the first stop most respondents picked, at 56 percent, and a psychiatrist or counselor's office drew 23 percent; 12 percent would research online alone and 1 percent would ask a friend.

The remaining 5 percent had no idea how they would begin, and they deserve attention. They are the patients most likely to leave your office without a next step unless you hand them one.

How common is the kind of patient we are talking about?

More common than "treatment-resistant" suggests. Among respondents, 72 percent reported standard medication failing to improve depression, anxiety, or PTSD for themselves or someone close: 37 percent meant themselves alone, 22 percent someone close, and 13 percent both.

Treat this as a signal, not a prevalence rate; it is self-reported from a consumer panel, and "did not help" is the respondent's word. But it matches what many clinicians see: patients cycling through medications with partial response and quiet frustration.

Do I need to be certified to refer?

No. Spravato is dispensed and given only through a restricted program; the site where it is administered must be certified, and patients are monitored there after each dose. Referring a patient to a certified center is an ordinary specialist referral. If you are thinking of offering treatment in your own practice, review the certification requirements published by the manufacturer and the FDA directly. For a picture of what a certified program tells patients, Brain Recovery Centers keeps a short Spravato explainer you can share.

What will patients worry about first?

Money, then distance. When we asked for the top two priorities in picking a provider, insurance made the list for 85 percent of respondents and closeness for 43 percent, with FDA approval third at 27 percent and speed of results next at 24.

We also asked how heavily coverage would weigh on trying treatment at all, and 65 percent said it would be decisive or nearly so. Offered a choice between a slower insured route with more paperwork and a faster self-pay one, half of respondents took the insured path, while self-pay and indecision divided the rest. So after naming the option, the most useful sentence may be: "Let's find out whether your plan covers it, and where the closest site is."

Which insurance should I plan around?

All of them. Respondents, who could select more than one, named commercial insurance and Medicaid at nearly identical rates, 39 and 37 percent, with Medicare named by 23 percent, TRICARE by 5, and no coverage at all by 9. For a Midwest practice, that argues for a short list of certified sites that take your state's Medicaid program and its managed care plans, not only commercial carriers. A referral to a site that will not take the patient's coverage is, in practice, no referral.

How do patients feel about ketamine therapy in general?

Mostly uncertain, not hostile. Among respondents, the top first reaction was cautious but open at 34 percent, plus 18 percent hopeful or curious, while 21 percent were skeptical and 9 percent negative; another 18 percent said the therapy was new to them. Combining the first two gives a 51 percent majority in the open camp, so most patients will want reassurance and plain information more than a pitch.

Separate the approved product from the rest. Only esketamine holds FDA approval for treatment-resistant depression; infused ketamine is prescribed off label for mood; at-home ketamine sits in a grayer area still. Patients who have read one headline may lump them together.

What words do patients actually use?

Not drug names. Our open question on search terms drew 319 answers, overwhelmingly about symptoms and need: "ptsd treatments," "depression medicine alternatives," and, from one respondent, just "someone please help me." If you want a patient to follow up, write down the treatment's name and the site; the words they would naturally search will not lead there.

Is there anything this survey cannot tell me?

Quite a lot. This article sticks to top-line figures, so it does not say whether any subgroup, such as Medicare patients or rural respondents, answered differently. It does not measure clinical outcomes, and it cannot say whether a given patient is a candidate; that remains a clinical decision.

If a patient discloses suicidal thoughts, tell them that dialing or texting 988 reaches a trained crisis counselor day or night, wherever they are. Keeping the number visible in exam rooms is a small act that can matter.

Methodology

Pollfish ran the survey for the publisher, which commissioned and paid for it, and closed fieldwork June 23, 2026. Completed responses totaled 443, from consenting adults between 18 and 64 who live across ten Midwest states. On questions allowing several picks, each share uses all respondents as the base, so totals can pass 100. The numbers are final; validation is complete.