From our survey
Saying no without seeming difficult: how to respond if esketamine comes up, steer toward drug-free options, and test any recommendation.
Sometimes the hardest part of an appointment is saying no. Your doctor raises ketamine or esketamine for depression that has not lifted, and something in you tightens. You do not want to seem difficult, but you also do not want to agree to something you truly doubt.
What follows is a script for that exact moment, meant for Missouri readers who are skeptical of ketamine therapy and want to steer toward other options, including ones without medication, without closing the door on help.
We commissioned a summer survey of 443 adults living in Missouri or one of nine neighbors in the Midwest. Asked how the idea of ketamine therapy first struck them, 21 percent of respondents chose "skeptical" and 9 percent "negative," which means close to a third began from doubt or opposition.
The same survey found drug-free care mattered to 64 percent of respondents while only 25 percent knew what TMS was. TMS is a brain stimulation treatment for depression that uses no medication. Because the survey has no breakdown for skeptics, their views on drug-free care cannot be pulled out separately, but many people clearly would welcome a conversation beyond pills. The figures are final.
Write down three things:
Acknowledge the suggestion, then state where you stand:
"Thanks for looking for new options for me. To be honest, I'm skeptical about ketamine. What exactly do you have in mind, and could you walk me through the alternatives too?"
That first question matters because "ketamine therapy" covers different things. Esketamine, the medicine in Spravato, is inhaled through the nose, approved for treatment-resistant depression, and given only under supervision at a certified healthcare site with monitoring afterward; if you want to read up before deciding, Brain Recovery Centers walks through what happens during Spravato treatment. Ketamine by IV is an off-label depression treatment, and products for home use face even lighter rules. Your concerns may fit one of these more than another, and you have a right to know which is being suggested.
To name the concern directly:
"What worries me is [the reputation, the side effects, another drug]. Can you help me understand that part?"
You need not wait for your doctor to raise alternatives:
"Before we go that way, can we talk about treatments without medication? Might TMS work for me? What about therapy?"
Your doctor may explain that TMS uses a coil on the scalp to stimulate a mood area of the brain, with no anesthesia or medication, and that its FDA clearance is for adult major depression where antidepressants have not worked. A course usually means visits most weekdays for several weeks.
Follow-up questions:
On that last point, the answer is nearly always to keep taking it until you and your prescriber agree on a plan, since stopping abruptly can cause withdrawal and bring symptoms back.
You can buy time without a permanent no:
"I'd like to think this over. Could you write down the options you mentioned, and can we book a follow-up?"
Getting the names on paper matters. In our survey, 73 percent of respondents had never heard of Spravato, and TMS awareness was barely better, so a vague memory will be hard to research later.
Skepticism works best applied evenly. Whether your doctor suggests ketamine, TMS, therapy, or another pill, ask the same questions:
Those questions match what respondents said they value: 59 percent would let FDA approval decide or strongly tilt the choice, and 85 percent placed insurance among their two leading provider priorities.
Ask where the nearest provider is for each option. Being near home made the top two for 43 percent of our respondents, which matters in a state where rural patients can be far from specialists; if TMS means a long drive, ask whether telehealth therapy is a sensible start.
On MO HealthNet, ask the office to confirm which options your plan covers and what paperwork it needs. Many plans require prior authorization and a record of past medication trials for TMS.
A doctor's word carries unusual weight, and 74 percent of respondents told us their own physician could most likely talk them into a new depression treatment. That trust runs both ways: a good doctor wants to hear your doubts, because people stick with treatment they believe in. Being skeptical is not being difficult; it is taking part in your own care.
If you are having thoughts of suicide, do not wait for the next appointment. Call or text 988 anywhere in Missouri, at any hour.
The publisher commissioned and paid for this study. Pollfish sourced respondents from its panel; data collection ended June 23, 2026, once 443 surveys were complete, every respondent a consenting adult between 18 and 64 from a ten-state Midwest sample. Results here are top-line, with no subgroup breakdowns, and come from the final validated data.