From our survey

What patients search before the visit: a St. Charles referrer FAQ

Every patient who brings up depression at a St. Charles County appointment has a backstory you rarely see: the searches they ran before they worked up the nerve to say something. This FAQ gathers the questions referring clinicians ask us most about that backstory, and answers them with what 443 Midwest adults told us in our survey.

The survey covered ten states, Missouri included. We cite no county-level data, so each figure below covers all ten states at the top line, from Pollfish's validated final file.

What are patients typing before they come in?

Mostly their feelings and their requests. Our write-in question asked what respondents would put in a search box when struggling, and 319 answered. "Best ways to handle depression" was typical; so was "therapist near me." Some were very short: "depressed." One was a plea: "someone please help me."

Do patients search for specific treatments by name?

Rarely, if at all. None of the phrases we are reporting names a drug. That tracks with awareness. Spravato, an esketamine nasal spray whose FDA approval is for treatment-resistant depression, was news to 73 percent of respondents. Twenty-one percent could only place the name; 6 percent could say what it does. For a plain description to share, see a patient-friendly Spravato summary.

If they are not asking about it, are they not interested?

Not asking and not interested are different things. Respondents' reactions to hearing "ketamine therapy for depression or PTSD" for the first time leaned toward openness: cautious but open drew 34 percent and hopeful or curious 18 percent, 51 percent together once counted from the raw answers. Skepticism came in at 21 percent, and 9 percent reacted negatively. Many patients simply do not know enough to ask.

Will patients come to me, or go straight to a clinic they found online?

Most say they would come to you. Fifty-six percent would bring a newer depression treatment up with their primary care doctor before anyone else. A psychiatrist or mental health provider drew 23 percent, and an online search drew 12 percent. Asking a friend came first for just 1 percent of respondents.

They are also inclined to follow your lead. Seventy-four percent picked their own doctor as the most persuasive voice.

How should I introduce esketamine to a patient who has never heard of it?

Describe it first, then name it. Something like: "If regular antidepressants have fallen short, one FDA-approved choice is a nasal spray named Spravato. Doses are given at a certified clinic, where staff watch you for a while after each dose, and someone else drives you home." Then turn to fit and coverage.

My patient has seen ketamine ads. How do I respond?

Acknowledge what they saw and sort it out. Plain searches can surface several different models: certified esketamine sites, IV ketamine clinics using ketamine off-label, and at-home telehealth ketamine services where no clinician is present during use. These differ in regulation, supervision, and often payment. Many patients will care about approval: approval from the FDA would settle or strongly shape the decision for 59 percent of respondents.

A family member did the searching. How do I involve them?

One respondent typed "how to help someone with depression." Caregivers often search on a loved one's behalf and may come to appointments. With the patient's permission, invite them in. They may remember medication history more clearly than the patient, and they may be the one providing rides if a treatment like esketamine is pursued. Friends and family also carry real influence: 18 percent of respondents picked a close friend or family member as their strongest influence.

Which payers should my St. Charles referral list account for?

More than one. Across the survey, commercial insurance (39 percent) and Medicaid (37 percent) led; Medicare followed at 23 percent, then 9 percent with no insurance and 5 percent on TRICARE. Multiple answers were allowed. For St. Charles County patients, that means knowing which MO HealthNet managed care plans, commercial carriers, and Medicare arrangements each clinic accepts. Coverage sat in 85 percent of respondents' top two, so this is often the deciding detail.

How far will patients travel?

Less far than you might hope. Nearness to home ranked second among top-two factors, picked by 43 percent. Esketamine involves frequent early visits, an observation period each time, and a driver. A clinic inside the county may be more realistic for many patients than one across the river, even if the St. Louis County option is better known.

Do patients want in-person or at-home care?

The larger share wants a clinic involved. In-person care was preferred by 44 percent, and clinic-then-home by 23 percent, a combined 67 percent. Telehealth at home with no clinic was the pick of 22 percent; 11 percent did not mind either way.

What handout should I give?

One that speaks the patient's language. Lead with symptoms and next steps, describe the treatment in plain words, and include the correct name so a later search lands on accurate information rather than on an at-home ketamine ad. Add the clinic's number and a line about insurance approval.

What if a patient's words suggest crisis?

Language like "someone please help me" calls for a safety assessment before any referral discussion. Follow your protocol, and hand the patient the Suicide and Crisis Lifeline, staffed at every hour and reached by calling or texting 988; veterans can press 1.

Scope

This FAQ reports survey findings on how patients search and choose care. It is not clinical guidance and does not address candidacy for any treatment, which remains a clinical judgment.

Methodology

Our survey went out on the Pollfish consumer panel, stayed open until June 23, 2026, and drew 443 responses. Ages ran from 18 to 64, and the respondents lived in Indiana, Kansas, Missouri, Nebraska, Ohio, Illinois, Minnesota, Wisconsin, Iowa, or Oklahoma. Search phrases are quoted from 319 open responses, and payer coverage was multi-select. Every figure is top-line, and validation is done. The publisher commissioned and financed the research.