Depression treatment FAQ

By the STL Depression Clinics Editorial TeamIndependent, medically reviewed for accuracy

Straight, plain-language answers to the questions people in the St. Louis area ask most about depression treatment, Spravato, TMS, cost, and finding a provider. If you are in crisis, call or text 988 at any time.

What is Spravato and how is it different from ketamine?

Spravato is the brand name for esketamine, a prescription nasal spray the FDA approved in 2019 for treatment-resistant depression. It is related to ketamine but is a distinct, standardized medication. It is given only in a certified clinic, where you are monitored for at least two hours afterward and arrange a ride home. Our Spravato guide covers it in more detail.

What is TMS?

TMS stands for transcranial magnetic stimulation. It is a non-drug, in-office treatment that uses focused magnetic pulses to stimulate mood-related areas of the brain. It is FDA-cleared for depression that has not responded to medication, involves no sedation, and you can drive yourself home after each session. See our TMS guide for what a course is like.

What does treatment-resistant depression mean?

Treatment-resistant depression generally means depression that has not improved after trying at least two different antidepressants, each at an adequate dose for an adequate length of time. It is common, it is not a sign you did anything wrong, and it signals that it is reasonable to consider options beyond standard prescriptions. Our page on when antidepressants stop working walks through the next steps.

Do I need a referral to see a depression specialist in St. Louis?

Not always. Many specialty and interventional clinics accept self-referrals, but some insurance plans require a referral for coverage. It is worth asking both the clinic and your insurer. A referral from your own doctor is not always required, but it often makes the first appointment easier to get and easier to trust.

Does insurance or MO HealthNet cover TMS and Spravato?

Many plans cover both TMS and Spravato for treatment-resistant depression when criteria are met, and they often require prior authorization. MO HealthNet, Missouri's Medicaid program, covers behavioral health services, but not every clinic accepts it, so ask directly. Your exact cost depends on your plan, deductible, and whether the provider is in network. See our insurance and cost guide for details.

What should I search for if I do not know the name of a treatment?

Search for how you feel, not a drug name. Phrases like my antidepressant stopped working, nothing helps anymore, or I have tried everything are valid reasons to reach out. You do not need to know the right treatment before you call. A good clinician expects you to arrive with symptoms, not a plan.

TMS or Spravato: which is right for me?

Both are used when standard antidepressants have not worked, and only a clinician can decide which fits your history. In general, people often lean toward TMS when they want to avoid adding a medication and prefer no sedation and no driving restriction, while Spravato may come up when a faster response is a priority. Many clinics offer both so the choice can be made together with a prescriber.

How do I find a certified Spravato provider near St. Louis?

Because Spravato requires certification through a federal safety program, ask directly whether a clinic is an enrolled Spravato provider. Certified care is usually found at specialty or interventional psychiatry clinics rather than a general primary care office. Hospital systems can also tell you whether they offer it or can refer you to a site that does. Our provider directory is a starting point.

Is it safe to drive after TMS or Spravato?

After TMS, most people drive themselves home and return to normal activities right away, because no sedation is involved. After Spravato, you cannot drive for the rest of the day and must arrange a ride home, because the medication can cause short-lived dizziness, drowsiness, or a dissociated feeling.

What questions should I ask when I call a depression clinic?

Useful questions include: Do you treat depression that has not responded to medication? What treatments do you offer, such as therapy, medication, TMS, or Spravato? Do you take my insurance or MO HealthNet, and what will a visit cost? How soon can I be seen? Will I see the same clinician each time? A clinic that answers plainly is showing you how it will treat you. Our guide on how to choose a provider has more.

What if I cannot afford treatment or am uninsured?

You still have options. Community mental health centers and nonprofit health networks in the St. Louis region serve uninsured patients, often on a sliding scale based on income. You may also qualify for MO HealthNet without realizing it, and applying is free. Manufacturer savings programs and clinic payment plans sometimes exist for advanced treatments, so it is worth asking.

When should I call 988?

Call or text 988, the Suicide and Crisis Lifeline, any time you are in crisis or thinking about suicide. It is free, confidential, and available around the clock. For a medical emergency, call 911. You do not have to be sure it is serious enough to reach out.