From our survey

On the fence about ketamine therapy in St. Louis? Read this

Most people asking about ketamine therapy in St. Louis are neither true believers nor critics. They sit somewhere in between, and their questions sound like it.

Our survey backs that up. Our 443 respondents, spread over Missouri, Illinois, and eight neighboring states, told us their gut feeling about ketamine or esketamine as a way to treat depression or PTSD. Roughly one in three respondents chose "cautious but open," the most common answer, and 18 percent said hopeful or curious. Together that is 51 percent leaning open, against 9 percent who reacted negatively. These are the final figures.

Below are the questions that come out of that middle ground, answered plainly. None of it is medical advice.

Is it normal to be unsure about this?

Yes. Unsure was the most common place to land in our sample. Skeptical came second at 21 percent, and 18 percent had never encountered the idea until we described it. Interested and wary at once is where the biggest group stood.

What exactly am I being unsure about?

Probably three things at once, which is why it feels murky. Esketamine, the medicine in Spravato, won FDA approval for adults whose depression stayed put through other treatment; you spray it yourself, but only at a certified site with a clinician watching, and you stay to be monitored afterward. Clinic IV drips of generic ketamine are a separate, off-label use. Ketamine prescribed over a video visit and mailed home is a third thing, and the least supervised. For a look at how one clinic sets up the approved version, Brain Recovery Centers has an explainer on Spravato treatment.

When someone in St. Louis says they "did ketamine," ask which one. The experience and the oversight differ a great deal.

Why have I never heard of the approved one?

You are far from alone. When we asked, 73 percent of respondents could not place the name Spravato at all. Most of the rest knew the word alone; 6 percent could explain it. Low awareness does not make something fringe; it mostly shows how rarely this comes up when people talk about depression.

Who should I ask first?

Most people would start with their own doctor. In our results, a primary care doctor was the first stop for 56 percent and a psychiatrist or therapist for 23 percent, On the separate question of persuasion, advice from their own physician led with 74 percent.

In practice that means your primary care office or current prescriber, whether part of a big St. Louis health system or a small practice. Write down every antidepressant you have tried and how long each lasted.

Does it matter whether it is FDA-approved?

It did to most people we asked. FDA approval would be the clincher or a heavy weight for 59 percent of those surveyed, and just 14 percent shrugged it off entirely. If it matters to you, ask any provider one simple question: is this the approved product for this use, or something off label?

Will my insurance cover any of it?

That depends on your plan, so find out before you get attached to a schedule. Coverage was the loudest concern in our survey; 85 percent put insurance among their top two provider priorities.

Whether your card says MO HealthNet, TRICARE, Medicare, or a commercial carrier, phone your plan with three questions: will it pay for esketamine, is prior authorization required, and which nearby certified sites are in network. Metro East residents may find different plan rules and different sites than people on the Missouri side.

Should I just pay out of pocket to skip the hassle?

Some people do, and that is a personal call. Still, half of our respondents said they would take the insured route despite extra hoops, 23 percent would pay to start sooner, and 26 percent could not say. Waiting on paperwork does not mean you are less serious about getting better.

Would I have to go somewhere in person?

For the approved spray, yes. It is given at a certified site, you are watched for a period afterward, and you should leave the car keys with someone else until the next morning, so plan a ride for every visit.

Most respondents were fine with that. An in-person clinic was the first choice of 44 percent, and 23 percent wanted to begin at a clinic and shift home later; telehealth from the start drew 22 percent.

Is there a way to explore this without any medication?

You can ask about drug-free options such as transcranial magnetic stimulation, or TMS. Half of our respondents did not know what TMS was yet wanted a drug-free choice. Your doctor can say whether it fits.

My family thinks it is a bad idea. What should I do?

Listen to the specific worry. Often it is the party-drug reputation or the at-home products, and it may ease once they know which version is being discussed. Family matters, but in our survey friends and relatives would sway 18 percent, far behind the 74 percent who would follow their own doctor. Bringing a skeptical relative to an appointment lets you both hear the same answer.

What should I be wary of?

Watch for a clinic that promises results, pushes a prepaid package, skips your medication history, or will not say plainly whether its product is FDA-approved. A careful provider asks more questions than it answers on the first call.

What if this is not about treatment options right now?

If suicide has been on your mind, put every question on this page down. Dial or text 988 and a counselor with the national Lifeline will answer, free and confidential, at any hour, and you can call about someone else too.

Methodology

The publisher commissioned and funded survey 395586438. Pollfish fielded it among consumer panel members until June 23, 2026, and 443 people between 18 and 64 finished it, living in both Missouri and Illinois plus eight more Midwest states; the sample was the general public, not St. Louis residents alone or patients. We report top-line percentages only, with no subgroup figures. Multi-select items appear as shares of respondents. Figures come from the validated panel.