From our survey

An esketamine primer for primary care on what patients miss

In our survey, the awareness number that should shape how you open this conversation is 7 percent: the share of 443 adults who said they could explain what Spravato is. Most of the rest, 73 percent, had never heard the name, while 21 percent knew it as a word and nothing else.

This primer is about the explaining you will have to do, not how to practice. It assumes you know the labeling; it is about the distance between the labeling and what the patient across from you has in mind.

The three things patients merge into one

In public conversation, "ketamine" covers at least three separate arrangements.

• Esketamine nasal spray, sold as Spravato. Its labeled uses are treatment-resistant depression in adults, given with an oral antidepressant, and adult major depression accompanied by acute suicidal ideation or behavior. Distribution is restricted, dosing takes place at certified sites, and post-dose observation is mandatory.
• IV racemic ketamine for mood, an anesthetic used off label, with protocols that differ from site to site.
• Ketamine prescribed for unsupervised use at home, usually through direct-to-consumer telehealth, also off label and under sustained regulatory and professional scrutiny.

A patient who has read one article or heard one podcast segment holds these as one undifferentiated thing. When they say ketamine "works fast," the referent is usually unspecified and often the least supervised of the three.

Why the distinction is not academic to them

Regulatory standing is one of the strongest drivers of willingness in our data. Respondents told us FDA approval would be decisive for them (19 percent) or weigh heavily (40 percent), 59 percent combined. It mattered somewhat to 27 percent and not at all to 14 percent. Separately, 27 percent put FDA approval in their top two provider attributes.

Patients use approval status as a stand-in for safety because it is the only quality signal a layperson can read. If nobody draws the approved versus off-label line for them, that signal attaches to whichever option markets itself most confidently.

What they are afraid of, and what they are not

First reactions were less hostile than clinicians often assume. The survey's split: cautious but open 34 percent, skeptical 21, hopeful or curious 18, unfamiliar 18, negative 9. Roughly half of respondents tilt open, and hard opposition is a single-digit share. Avoiding the subject because it might land badly mostly guards against a small minority. The dominant state is blankness, not resistance.

The history behind the blankness

Asked about their own lives, 72 percent of respondents described personal or close exposure to hard-to-treat depression, anxiety, or PTSD, the kind ordinary prescriptions did not help. Of the whole sample, 37 percent meant themselves, 22 percent a person in their life, and 13 percent both; 28 percent reported no such exposure.

Many of these people have already been through first-line treatment and stopped bringing it up. Silence in an exam room is not always satisfaction. Sometimes it is a patient who decided the menu had run out.

The words they use

We asked what people would search for when seeking help, and all 319 open-text answers were symptom language, from "ptsd treatments" and "therapist near me" to "depression medicine alternatives." Not one named a pharmaceutical.

Access constraints your patients will hit first

Coverage dominated every preference question in the survey. For 85 percent, insurance was one of the two things that mattered most, far ahead of nearness at 43 percent. FDA approval came next at 27 percent, results speed at 24, then discretion at 11, with a service-focused practice last at 10. For 65 percent, insurance would be decisive or major in whether they pursued treatment at all. Faced with a choice, 51 percent would take more paperwork to stay covered, while 23 percent would rather pay to move faster and 26 percent could not say.

Respondents could list more than one payer: commercial plans at 39 percent, Medicaid at 37, Medicare at 23, no coverage at 9, and TRICARE at 5.

The referral details follow directly. Prior authorization rules, documentation of earlier antidepressant trials, the site's network status, and whether drug and administration bill separately decide whether a referral becomes an appointment. For a sense of how one certified site explains that process to patients, Brain Recovery Centers keeps a patient page on Spravato care you can point people to.

Logistics that patients underestimate

Supervised dosing with observation and a required ride is a real recurring commitment, and stated preferences do not automatically fit it. In the survey, 44 percent favored in-person clinic care, with telehealth at home at 22 percent, a mixed start-in-clinic plan at 23 percent, and 11 percent indifferent. Spend two minutes on transport, time off, and childcare; attrition here is often logistical, not clinical.

Two subpopulations worth noting

We also asked who respondents are. Twenty-nine percent said they are a parent or other relative of someone who served or serves as a first responder, 6 percent a spouse or partner, 4 percent first responders, and 2 percent veterans or active military. Taken together, about 7 percent were themselves veterans or first responders, and a far larger share live next to that experience.

That matters when a veteran or service family member sits in a civilian primary care office assuming their options are limited to what is in front of them. Some carry TRICARE, some a civilian plan. Knowing where each kind of referral goes before the visit keeps that assumption from ending the conversation.

What the survey does not tell you

These are whole-sample figures from a general population panel, and this primer cites no cross-tabulations, so nothing here supports claims about how a subgroup answered. They say nothing about efficacy, safety, or suitability for any patient; eligibility, contraindications, and monitoring are clinical determinations under the label and the individual case.

What the data does establish is the starting point: substantial unmet need, near-total unfamiliarity with an approved option, an open rather than hostile disposition, and a decision process run by coverage.

When suicidality is present, write 988 down for the patient rather than just saying it. Calls and texts to it reach crisis counselors anywhere in the country, free and confidential, at every hour.

Methodology

The publisher commissioned and funded this first-party study. Fieldwork ran on the Pollfish consumer panel and wrapped on June 23, 2026, with 443 consenting adults aged 18 to 64 taking part. Where more than one answer could be chosen, the shares add to more than 100. We report no cross-tabulations here. Each figure was checked against the panel's final validated export.