Unsure about ketamine therapy? A St. Louis doctor script

Nobody needs to arrive at the doctor's office already sold on ketamine therapy. You can walk in unsure what you think about it, and say so.

That is actually the most common place to stand. Our survey put ketamine and esketamine care for depression or PTSD before 443 adults in ten Midwest states and recorded first reactions, and the top answer, picked by 34 percent, was "cautious but open." Add the hopeful or curious, another 18 percent, and 51 percent leaned toward yes; a flat no came from 9 percent. The figures are final.

If your honest position is "maybe, but I have questions," this script is for you. It is written for a St. Louis patient, but the words travel.

Why say your caution out loud

People hide ambivalence in exam rooms. They nod, take the pamphlet, and never call, or they fear sounding eager and never raise the subject.

Your doctor can work with uncertainty far more easily than with silence, and your doctor is also the voice you are most likely to trust here. Our respondents said so: asked which voice could persuade them, 74 percent chose their own physician, compared with 18 percent for friends and family and 2 percent for an ad. Your caution is the reason to have this conversation with the one person whose opinion you will weigh.

The opening

Say this early in the visit, not at the door on your way out.

"I want to ask about something I am unsure about. I have heard about ketamine for depression and I honestly do not know if it is real medicine or a trend. I am not asking you to prescribe it. I am asking whether it is even a question for someone like me."

That tells your doctor you are not shopping, and it asks for their judgment, which is what you came for.

Give the history in plain terms

Before any new treatment comes up, your doctor has to hear what has already been tried. Something short works.

"I have been on two antidepressants. The first I took for about four months and nothing changed. The second helped a little, then stopped helping. I am still on it. Most days I get through work, and then I am done."

Use your own details; clinical language is not required. The search phrases our respondents wrote, like "how to cope with my anxiety" or "best ways to handle depression," show how real people describe this, and that is enough.

Ask the question that separates the three

"Ketamine" is doing a lot of work in public right now, and your caution is probably partly about that. Ask directly.

"When people say ketamine for depression, are they talking about one thing or several? Which of those, if any, would you be comfortable with?"

A good answer separates at least three. Esketamine, marketed as Spravato, is a spray the FDA approved for depression that other medicines did not relieve; every dose happens inside a certified clinic, and you are watched for a while after. Ketamine by IV drip, used for depression, is off label. Ketamine prescribed through a telehealth service for use at home is a third arrangement with much less oversight. If you want to read how a clinic describes the supervised version before your visit, Brain Recovery Centers publishes its own description of Spravato care.

If the name Spravato is new to you today, you are in the large majority: 73 percent of our respondents had never run into it.

Name what would make you comfortable

Caution usually comes with conditions, so say yours. Our data hints at common ones: 59 percent of respondents called FDA approval a deciding or big factor, and 65 percent said that about insurance. You might say:

"If this ever made sense for me, I would want the approved version, in a real medical setting, covered by my plan. Is that realistic?"

You are allowed to set those terms. If your doctor says some are not realistic for you, that is useful too.

Ask what comes before it

"What should we try or rule out first? Is there a therapy change, a medication change, or something drug-free like TMS that makes more sense right now?"

That last option matters to many people. In our survey, a drug-free route appealed to 64 percent, even though TMS itself was known to only 25 percent. You can ask without knowing much; your doctor can say whether it fits.

Leave with a next step, not a decision

You need not decide anything in the room, but try not to leave empty-handed.

"I do not want to commit today. Can we agree on a next step, maybe a referral for an evaluation, or a follow-up in a month?"

In St. Louis, that step might be a psychiatrist in your health system, a certified site elsewhere in the metro, or, if you carry TRICARE, whatever referral that plan requires. If you live on the Illinois side, mention it, since coverage and site options change across the river.

If your doctor is not familiar with it, that is not a reason to drop it. Ask, "Would you look into it, or refer me to someone who knows more?" Asking for a psychiatry referral is fair when depression keeps outlasting treatment, whatever the eventual plan.

What this script will not do

It will not tell you whether ketamine or esketamine is right for you; no one writing online can. That depends on your diagnosis, your history, and your other medications, and it is your clinician's call. The script only makes sure your caution is heard as a question instead of a no.

If what you carry has moved past treatment questions into thoughts of ending your life, reach out tonight rather than at the appointment. Call or text 988 from any U.S. phone; the Lifeline answers at every hour and charges nothing.

Methodology

These figures come from a survey we commissioned as publisher and paid for in full. Pollfish ran it on its consumer panel (ID 395586438); 443 adults 18 to 64 answered before the June 23, 2026 close, from Missouri, Illinois, and eight more states in the region. It was not limited to St. Louis and did not screen for diagnosis. Results are top-line only, with multi-select answers shown as shares of respondents. Numbers here follow Pollfish's final validation of the panel.