From our survey

Paying yourself: esketamine and ketamine questions in St. Louis

These are the questions people in St. Louis ask when they are paying for depression care themselves and have just come across the words "esketamine" or "Spravato." The answers are plain, and where we cite numbers, they come from a June 2026 survey of 443 Midwest adults, paid for by our publisher.

What is Spravato?

Spravato is esketamine in a nasal spray. Its first FDA approval covers adults for whom two or more antidepressants have not brought enough improvement; a second covers depressive symptoms in adults whose major depression includes acute suicidal thoughts or behavior. Treatment takes place only in certified centers, under supervision.

Why have I never heard of it?

You are far from alone. Our survey asked about Spravato directly, and 73 percent of respondents said they had never heard of it. A further 21 percent knew the name only. That left 6 percent who could say what it was. The numbers are final; the survey panel has completed its validation.

Esketamine is not heavily advertised, and it is not something a pharmacy fills for home use, so most people only learn about it from a clinician.

Is it the same thing as the ketamine clinics I see advertised?

No. Ketamine clinics usually offer IV infusions of ketamine, which is FDA-approved as an anesthetic but used off-label for depression. Online companies may prescribe ketamine tablets or lozenges to take at home, also off-label and without in-person monitoring. The FDA has publicly warned about the risks of compounded ketamine used at home.

Esketamine is a distinct FDA-approved product with a specific approved use. If a St. Louis provider offers "ketamine therapy," ask which one they mean. A patient overview of Spravato describes the approved one.

Can I get esketamine without insurance?

Possibly. Certified treatment centers can see self-pay patients, and the manufacturer runs patient support and assistance programs with their own eligibility rules. Ask any center you contact whether they work with uninsured patients and whether they help with assistance applications. Get a written estimate before starting.

First, though, check whether you actually qualify for coverage. MO HealthNet eligibility was widened to many working-age adults under Missouri's Medicaid expansion. Marketplace plans with income-based subsidies are another option, especially after a job loss or other life change.

Why does it cost so much?

You are paying for the medication, which has a high list price, and for time at a certified center, including two or more hours of observation per dose. A course typically begins with two sessions a week for about four weeks, then weekly for another month, then weekly or every two weeks depending on response. The total adds up quickly. Ask about the cost of the full course, not just one session.

Is at-home ketamine cheaper and just as good?

It may cost less per dose, but it is not the same treatment and has not been approved for depression. At-home use removes the in-person monitoring that the approved product requires. A clinician familiar with your health should decide whether any version fits you.

Where treatment happens was a real preference for respondents. An in-person clinic was the top choice at 44 percent, while a clinic-then-home approach drew 23 percent, at-home telehealth 22 percent, and 11 percent had no preference. Keep in mind those are preferences about convenience, not findings about safety.

Does FDA approval matter?

It mattered to most of the people we asked. Fifty-nine percent said FDA approval would carry deciding or heavy weight in trying the treatment, and 27 percent listed "FDA-approved" as a top-two provider trait. If approval matters to you, make sure you know which product is being discussed.

No doctor yet. Where do I begin?

Sliding-scale federally funded health centers operate throughout the city and the county, many with behavioral health services; look them up by ZIP code at findahealthcenter.hrsa.gov. Area mental health centers that take public funding will also see you, insured or not.

Most people in our survey would turn to a professional first: primary care led at 56 percent and psychiatry followed at 23 percent, while an online search came in at 12 percent.

What should I bring to that first visit?

Every antidepressant you have taken, listed with its dose and how long
Your other medications and health conditions
A note of how depression is affecting your work, sleep, and relationships
Your questions about cost, written down

How do I ask about cost without feeling awkward?

Just say it: "I'm paying for this myself. What will this visit cost, and what would treatment cost if you recommend it?" Sliding-scale clinics hear that every day. Asking early helps them point you to programs you can use.

Would I be better off waiting for insurance?

That is a personal tradeoff. When we asked respondents to choose, just over half said they would take insurance coverage even with more hoops, 23 percent would pay for a simpler start, and 26 percent were not sure. The 39 uninsured respondents leaned the other way, with only 38 percent choosing the covered route. If you are leaning toward paying, it is still smart to start a coverage application at the same time.

What if I can't get to a center twice a week?

Tell the clinician. Transportation is a real barrier, especially because esketamine patients may not drive until they have slept. A clinician may suggest a different approach, or a center with more flexible hours. Being close to home ranked second among priorities in our survey, chosen by 43 percent, behind only coverage.

Is there anything I can do tonight?

Yes. Write your medication list. Look up one sliding-scale clinic near you. Check your Medicaid eligibility online. Any one of those is progress.

And if tonight feels unsafe, if thoughts of ending your life are pressing on you, text or dial 988 now; the Suicide and Crisis Lifeline is confidential, costs nothing, asks nothing about insurance, and lets veterans press 1.

Methodology

These figures are drawn from our Pollfish consumer panel survey, completed before its June 23, 2026 close by 443 adults aged 18 to 64 in Minnesota, Wisconsin, Ohio, Indiana, Illinois, Oklahoma, Kansas, Nebraska, Iowa, and Missouri. Apart from the uninsured breakdown, the results cover the whole sample, with no city cut, and all are final. Our publisher commissioned the study and funded it.