From our survey

Push, wait or invite: how St. Louis families raise treatment

When someone you love has depression that the usual medicines have not lifted, and you have read about a treatment they might not know exists, you have roughly three choices. You can push. You can wait. Or you can invite. St. Louis families try all three, often in the same month.

This comparison looks at each approach in turn, leaning on answers from 443 Midwest adults in a June 2026 survey that the publisher financed. The figures come from the final validated data; most describe the whole sample, and the one group figure below names its group.

The ground you are standing on

Two findings shape everything below.

First, people are more open than families fear. On our first-reaction question, 34 percent of respondents picked "cautious but open" about ketamine for depression or PTSD and another 18 percent felt hopeful or curious, 51 percent when the two are counted together. Skeptics were 21 percent. The share who reacted negatively was just 9 percent.

Second, families are not the main persuaders. We asked whose word would actually get someone to try it. Their own doctor, said 74 percent. A friend or relative, said 18 percent. Respondents whose child, sibling or other relative serves or served in the armed forces, on a fire crew, in policing or in EMS, a group of 129, put even more weight on the doctor, at 75 percent.

Keep those two facts in mind as you compare the approaches.

Approach one: push

What it looks like. You make the case, forcefully and often. You send articles, book appointments, bring it up at dinner, enlist siblings. The logic is understandable: this is serious, time matters, and you are scared.

When it can seem to work. Occasionally a person who was already leaning toward yes will go along with a push, and feel relieved someone else took charge.

Why it usually backfires. Most people start out cautious, and caution hardens into refusal when someone feels cornered. An adult who is pressured may agree just to end the conversation, then cancel the appointment. Pushing also puts you in the role of advocate for a specific treatment, when the decision about whether it fits belongs to a clinician.

Risk to watch. A pushed person may feel their depression is being treated as a problem for the family to solve rather than an illness they are living with. That can damage trust at exactly the moment it matters most.

Approach two: wait

What it looks like. You say nothing, hoping your loved one will discover the option on their own or that their doctor will bring it up.

When it makes sense. Waiting is right when your loved one has asked for space, when they are already actively working with a clinician on a plan, or when a conversation right now would do more harm than good.

Why it often stalls. The awareness numbers are the problem. Spravato is an approved esketamine spray for depression that has resisted other treatment, yet the name meant nothing to 73 percent of our sample, and a slim 6 percent could say what it is. Waiting for someone to stumble onto a treatment most people have never heard of can mean waiting indefinitely. And appointments are short. A doctor juggling many issues may not raise it unprompted.

Risk to watch. Silence can feel like indifference to someone who is struggling.

Approach three: invite

What it looks like. You share information once, with permission, and pair it with an offer of practical help. Then you step back and let your loved one decide.

"I read about something for depression that hasn't gotten better on regular medication. Can I tell you what I found? You don't have to decide anything. If you'd like to bring it to your doctor, I'll help however you want."

Why it tends to work. It fits both findings. It respects caution, which is where most people start. And it points toward the doctor, the voice people trust most, rather than trying to make you the decision-maker. It also makes you useful in the ways families actually are: noticing, supporting, and helping with logistics.

Risk to watch. Inviting takes patience. Your loved one may say "not now" several times. That is part of the approach, not a sign it failed.

Side by side

• Respects the person's autonomy: Push, poorly. Wait, fully. Invite, fully.
• Closes the awareness gap: Push, yes but at a cost. Wait, rarely. Invite, yes.
• Directs the decision to a clinician: Push, often not. Wait, only if the doctor raises it. Invite, yes.
• Protects the relationship: Push, at risk. Wait, usually. Invite, usually.

Making "invite" concrete in St. Louis

• Know the three things called ketamine therapy. Esketamine carries FDA approval and is only ever given in certified centers, under observation. IV infusions and take-home ketamine are both off-label for depression, and regulators have warned against home use with nobody present. Being able to explain the difference makes your invitation more credible. Brain Recovery Centers keeps a page on the approved spray if you want the details in one place.
• Offer rides. Esketamine rules out driving until the day after a session, following sleep, and the first weeks usually mean two sessions a week. Across a metro area that spans both sides of the river, a reliable driver is a big deal.
• Offer to check coverage. Carrying your loved one on your own plan means you can ask the insurer directly whether esketamine is covered and needs prior authorization. Eighty-five percent of respondents ranked coverage among their top two priorities.
• Offer to help book the doctor visit. That is where the decision will actually be made.

A note on emergencies

Drop the comparison entirely if your loved one has spoken of wanting to die or you fear they could hurt themselves. Dial or text 988, where Suicide and Crisis Lifeline counselors pick up; a relative can phone on someone else's behalf, any time, and get help deciding what to do.

Whether esketamine, or anything else, suits your loved one is for a clinician familiar with their history to judge.

Methodology

Our publisher bankrolled this study and had it run on the Pollfish consumer panel, which shut the survey on June 23, 2026 with 443 people through to the end. Everyone taking part was between 18 and 64, from Wisconsin, Iowa, Kansas, Missouri, Indiana, Minnesota, Illinois, Ohio, Nebraska, and Oklahoma. Our numbers are the validated final set; subgroup cuts appear only where a group has at least 30 people.