When a Missouri patient raises at-home ketamine first

"I saw an ad for ketamine you can do at home. Should I try it?"

Primary care physicians in Missouri hear some version of that sentence more often now, usually at the end of a visit about something else. The patient has been on antidepressants a while, is tired of waiting for one to work, and has found something online that promises a shortcut.

Your next two minutes matter more than you might think. Our commissioned survey heard from 443 adults living across ten Midwest states, Missouri included, and their own doctor's recommendation would be the deciding push for 74 percent of them to try ketamine or esketamine therapy, against 2 percent for advertising. The ad got the patient to ask; your answer decides what happens next. These numbers are final.

This is a response script for that moment, not guidance on who should be treated.

First, thank them for asking

A patient who raises this is taking a risk; they may fear you will dismiss them or think they are drug-seeking. Lower that guard first:

"I am glad you brought this up with me instead of just signing up. Let us talk about it properly."

That keeps the question in your office. A patient who feels brushed off and goes ahead alone is worse for everyone.

Find out what they actually saw

Patients rarely know which product they mean, which fits our data: 73 percent of our respondents had no knowledge of Spravato, and only 6 percent could describe it. The ad in their feed is almost certainly not for the approved product.

"Tell me what you saw. Was it a program that mails medication after a video visit, a clinic that does IV infusions, or something else?"

The answer tells you which conversation you are about to have.

Separate the three, briefly

The patient needs a map, not a lecture.

"People call three different things ketamine treatment. One is a nasal spray called esketamine, brand name Spravato, which carries FDA approval when other antidepressants have not worked; you take it in a certified clinic, stay about two hours to be monitored, and do not drive until the next day. The second is IV ketamine at a clinic, an off-label use. The third is what you saw, ketamine prescribed over video and taken at home with nobody in the room. They are not interchangeable."

Acknowledge the appeal of home

Do not pretend the at-home option has no pull. In our survey, 22 percent of respondents preferred at-home telehealth and 23 percent wanted a clinic start before moving home, though the largest group, 44 percent, preferred an in-person clinic.

"I understand why doing this at home sounds easier. A lot of people want that. Many people also want someone watching the first time they try something like this, and for the approved version, that is how it is done."

Raise approval and coverage together

These concerns travel together in patients' minds. FDA approval was deciding or major for 59 percent of the people we asked; insurance was for 65 percent.

"Two things most people care about here are whether it is FDA-approved and whether insurance helps pay. The at-home programs are usually off-label and usually self-pay. The approved spray is more likely to be something your plan will consider, often with paperwork. Would it help if my office looked into what your plan covers?"

For Missouri patients, that plan may be MO HealthNet, Medicare, a commercial carrier, or TRICARE; in our sample, 39 percent of respondents reported a commercial plan and nearly as many, 37 percent, Medicaid. Do not assume the patient knows what their plan will do. Offer to find out, and if they want to read ahead, point them to a clear source such as Brain Recovery Centers' explanation of how Spravato is given.

Review the history before any decision

"Before we decide anything, let us go through what you have been on. Which medications, how long, what happened with each. That tells us whether you might qualify for the approved option and what else we should consider first."

Among our respondents, 72 percent reported, for themselves or someone close, depression, anxiety, or PTSD that routine medications never resolved. The patient in front of you is not unusual; treat the question as a legitimate clinical one.

Offer other options too

"Depending on your history, there are other things to consider as well: adjusting medication, a different therapy approach, or a drug-free option like TMS. I want to look at all of them with you."

In our survey, 64 percent put weight on avoiding medication, though only about a quarter knew what TMS was.

Name a next step before they leave

A patient who leaves without a plan often goes back to the ad. Give them something concrete:

"Here is what I suggest. Hold off on signing up for anything for now. I will refer you for an evaluation, and my office will check your coverage. We will talk again in two weeks either way."

If you are referring for it, write "esketamine (Spravato)" on a card. People search in plain language; our respondents' search phrases included "depression medicine alternatives" and "someone please help me," so the card points them to the right search.

If they are determined to go ahead

"If you decide to go that route, please tell me, and please keep me updated. I would want to know what you are taking and how you are responding."

A patient who keeps coming back is safer than one who stops.

Close with safety

Depression that has not responded to treatment carries real risk. Before the visit ends, ask directly about suicidal thoughts if the history warrants it, and make sure the patient knows 988 connects them to the Lifeline by call or text, free, day and night. Say the number aloud, and write it on the same card.

Methodology

This publisher commissioned and funded the survey, Pollfish study 395586438, which closed June 23, 2026 on the Pollfish consumer panel. Its 443 respondents came from the general public rather than from physicians or a patient list, and all were adults aged 18 through 64 in the ten-state region. We report only top-line figures, with no subgroup cuts, and multi-select items as shares of respondents. Every figure reflects final validation.