From our survey
Caregiver questions about ketamine and esketamine, answered
For the spouse, son or friend with questions nobody has answered: the difference, who decides, insurance, waiting, and what if it is a no.
There is a list of questions in your phone that you have not asked anyone. You are not the patient. You are the wife, the son, the best friend, and part of you is not sure the questions are yours to ask.
They are. We surveyed 443 people in ten Midwest states about ketamine and esketamine therapy, including what it would take for them to try it. A recommendation from their own doctor led with 74 percent; friends and family drew 18 percent, a uniformed figure they follow online got 4 percent, advertising 2, and podcasters a single percent. That points a family member's job somewhere specific: not winning an argument, but getting a real conversation started with a clinician.
The numbers are final, and nothing below is medical advice.
What is the difference between ketamine and esketamine?
Esketamine is a specific formulation, sold as Spravato, with FDA approval limited to treatment-resistant depression. The nasal spray is taken under supervision in a certified setting, and the patient is monitored before going home, a requirement written into the approval itself. Brain Recovery Centers has a short explainer on Spravato showing how one clinic runs those visits.
Ketamine arranged some other way, including programs that ship it to a home after a telehealth visit, sits in a different and much looser space. It is not the same product or held to the same oversight, though the marketing for both often sounds identical.
Why had I never heard of any of this?
Almost no one has. Spravato was an unheard-of name for 73 percent of those we surveyed; 21 percent recognized it vaguely, and 6 percent knew what it was.
Reactions among respondents were mixed but not hostile. From smallest to largest: negative 9 percent, never heard of it 18, hopeful or curious 18, skeptical 21, cautious but open 34.
Who actually decides whether this is appropriate?
A clinician does, and not from a website. Suitability depends on the diagnosis, which medications have been tried and for how long, other conditions and prescriptions, and the patient's own preferences. So the most valuable thing you can assemble is a record, not an argument: every antidepressant your person has taken, roughly when, roughly how long, and why it stopped.
How do I bring this up with their primary doctor?
Most respondents would start there too: 56 percent named the primary doctor as their first stop, 23 percent a psychiatrist or therapist, and only 12 percent an online search.
The ask can be short: the depression has not improved on the medications tried so far, we have read that options exist for depression that does not respond to standard medication, and we want to know whether a referral makes sense. You need no brand name or plan, just the subject on the agenda in a visit with time for it.
What if they refuse to go at all?
No technique reliably solves this. The data suggests where not to spend energy: only 2 percent said an ad would move them, so more evidence piled on the kitchen table is unlikely to help.
What remains is smaller and often more effective. Lower the ask from "try this treatment" to "keep one appointment." Handle the logistics yourself, since scheduling and transport sink more attempts than reluctance does. And remember that 5 percent of respondents said they would have no idea how to start; refusal is sometimes paralysis wearing a confident face. You cannot consent for another adult. You can keep the door open and be ready the day they say yes.
What should I ask about insurance?
Ask early, because coverage shapes everything. For 22 percent of respondents insurance was the deciding factor and for 43 percent a big one, while 85 percent ranked coverage first or second when picking a provider.
Ask the treating office whether it bills your insurer directly, whether prior authorization applies, which past-medication records it wants, and the patient's cost per visit. Ask the insurer what coverage requires and how long a decision takes. Log names and dates.
And paperwork delays are normal: offered insured care with extra hurdles or a faster self-paid start, half of respondents took the hurdles, while 23 percent would pay and 26 percent were unsure.
How long does it take to get started?
Longer than one phone call. There is usually a primary care visit, often a referral, an evaluation by the prescribing clinician, and in many cases an insurance authorization. You can run steps in parallel: request records while you wait on the referral, and start the insurance questions before the evaluation.
Is it strange that I am the one doing all of this?
Not at all. Among the people we surveyed, 72 percent had lived close to depression, anxiety, or PTSD that routine prescriptions could not settle: for 37 percent it was their own, for 22 percent someone close, for 13 percent both, and 28 percent had neither. Households carrying this are ordinary, and so is your role. Watch your own reserves, though; caregiver exhaustion arrives quietly.
What do I do if things get worse while we are waiting?
Treat a crisis as its own emergency, separate from any plan in progress, and do not wait for an appointment weeks away. If there is immediate danger, call 911 and tell the dispatcher this is a psychiatric emergency. Otherwise call the prescribing or primary office, say plainly that things have escalated, and ask what to do today.
What if the answer turns out to be no?
A clinician may decide this treatment is not right for your person. That closes one door, not all of them; it is one option among several, and the conversation you started put the real problem in front of someone qualified to work on it.
Keep this last part where you can find it fast. The 988 line takes calls and texts from anywhere in the country, day and night, and welcomes family members worried about someone else. If the person you love is talking about dying, or you are frightened and unsure what to do next, that line exists for exactly this moment.
Methodology
Every percentage above comes from survey ID 395586438, which the publisher commissioned and funded and which Pollfish fielded among its panel members. Its final sample, n=443, came from ten Midwest states and the 18 to 64 age range, and fieldwork closed June 23, 2026. Multi-answer results are shares of all respondents, so they total over 100. Every figure has been through final validation.