You get about fifteen minutes. The nurse takes vitals, the doctor asks how things are going, and then comes a window where whatever you say decides the next three months. Most people fill it with "he's been kind of down lately," and the appointment ends.

We paid to survey 443 adults across ten Midwest states about depression care, and one number shows why that window deserves preparation. Asked whose recommendation would lead them to try ketamine-type therapy, respondents chose their own doctor 74 percent of the time and an ad 2 percent. The data is final, and the shape is unmistakable: this decision gets made in an exam room, not on a website.

Three things on a card, written the night before

• A medication timeline: name, roughly when it started and stopped, and why
• Two or three sentences on daily life now, in behavior rather than mood words: missed shifts, skipped meals, days without leaving the bedroom
• One sentence naming what you want from this visit

Write the third one plainly:

What I want from today is a plan for what we try next, because the current plan has not worked for about eight months.

How to open

Do not start with a treatment name. Start with a fact the doctor can act on.

I want to talk about my husband's depression. He has been on three different medications over two years, and he is not better. I am worried we are just waiting.

Describing what was tried, without overselling it

The instinct is to make it sound worse so it gets taken seriously. Resist it. Exaggeration loses the doctor fastest, and accuracy persuades better. Include the parts that complicate the story.

He took the first one for about four months at the full dose. It helped a little for a few weeks and then stopped. The second one he quit after three weeks because of the side effects, so I do not think that was a fair trial. The third one he has taken exactly as prescribed since March, and there is no change.

Admitting the second trial was not fair makes the rest more credible. Then add the concrete detail:

He used to coach his daughter's team. He has not been to a practice since February. He is sleeping about twelve hours a day and he has stopped answering his brother's calls.

Say the phrase

A clinical term fits this situation, and using it puts the conversation on a track the doctor recognizes. Ask it as a question, since you are inviting a diagnosis, not making one:

Is what he has treatment-resistant depression? If that is the right description, what does the path look like from here?

Asking about esketamine and other next steps

Ask about the category first and the product second; you are asking whether an option exists, not requesting a prescription.

When two or three medications have not worked, what options are there beyond another antidepressant?

Then, if it does not come up on its own:

I have read about esketamine, the Spravato nasal spray, which the FDA approved for depression that has not lifted with other drugs and which is given under supervision in a certified clinic. Is that worth considering for him, or is there a reason it would not fit?

Keep that sentence precise, because two different things share a word. Approved esketamine is given in a certified setting with monitoring afterward; at-home ketamine, usually compounded and shipped after a video visit, is a separate and grayer category. Before you go, you can see how one certified program lays out its visits in Brain Recovery Centers' description of its Spravato visits.

And be ready for a no that is about him specifically; that is the answer you came for. Whether a treatment suits one person depends on a history only a clinician who knows him can weigh.

Asking for the referral

With a family physician, the realistic outcome is often a referral rather than a decision, so ask for it directly.

Would you refer him to a psychiatrist who works with treatment-resistant depression? And can we get that sent today so it does not sit?

In our survey, 56 percent said they would start with their primary doctor, 23 percent with a psychiatrist, and 12 percent with an online search. Starting with the family doctor is the common instinct; leaving with a referral turns it into a real next appointment.

If the doctor has not heard of it

This happens, and it is no scandal; recognition is genuinely low. In our sample, Spravato meant nothing to 73 percent, was a hollow name to 21 percent, and was understood by only 6 percent. Stay neutral.

No problem. Is there someone you would send us to who works with this more often?

If the answer is no

A refusal is a dead end only if you leave without the reasoning.

That is fine, I just want to understand it. Is it a no for him specifically, or a no in general? What would have to change for it to be on the table? And what would you try before that?

Before you leave the room

Read the plan back aloud. It takes twenty seconds and catches misunderstandings while someone can still correct them.

So to make sure I have it: we are increasing the dose, the psychiatry referral goes out today, and we check back in six weeks. Is that right?

Plain speech beats borrowed vocabulary. When 319 of our respondents typed what they would search for help, almost none used a drug name; they wrote "how to help someone with depression" and "depressed." That is what a clinician needs to hear.

Finally, the sentence that overrides every script above. If the person you are worried about has talked about ending their life, or you are scared and cannot tell how serious it is, you need not hold that alone until the next opening on the schedule. The 988 Lifeline takes calls and texts around the clock, for the person struggling and for the people trying to help.

Methodology

The publisher commissioned and funded this consumer survey. Pollfish carried it as survey ID 395586438, and 443 adults, all 18 to 64 and all from ten Midwest states, finished it before the June 23, 2026 cutoff. Multi-answer questions are tallied per respondent, so they exceed 100. The panel's validation is final, and so are these figures.