What 443 Midwest Adults Said About Who They Trust on Depression Care

We ran a survey because we were about to spend money on the wrong thing.

The plan was a familiar one for a clinic offering a treatment most people have never heard of: run ads, buy awareness, and wait for the phone to ring. Before committing to it, we paid to ask 443 adults across ten Midwest states what would actually make them try a new depression treatment. The answer came back lopsided enough to change how we think about reaching people.

Seventy-four percent said the thing that would move them is a recommendation from their own doctor. Two percent said an ad.

What we asked and who answered

The study ran on the Pollfish consumer panel and closed on June 23, 2026 with 443 completed responses. Respondents were adults aged 18 to 64 across Missouri, Illinois, Iowa, Nebraska, Kansas, Oklahoma, Indiana, Ohio, Wisconsin, and Minnesota. It was a broad general-population read, not a screened patient list, which matters: these are ordinary people, not people already shopping for care.

Every figure below comes from the final validated data, after the panel finished its data-quality checks on each response.

The finding that reorders everything

We asked whose recommendation would most make someone actually try ketamine or esketamine therapy for depression or PTSD. The spread was not close:

• My own doctor: 74 percent
• A close friend or family member: 18 percent
• A veteran or first responder I follow online: 4 percent
• An ad I saw: 2 percent
• A podcast host I trust: 1 percent

A separate question pointed the same direction. When asked who they would go to first if they wanted this treatment, 56 percent named their primary doctor and 23 percent named a psychiatrist or mental-health provider. Only 12 percent said they would search online themselves.

An ad can tell a person that a treatment exists. In this survey, it almost never decided anything. The decision happens in an exam room.

We are a treatment provider, and buying ads is the easy move for any clinic with a new service to fill. This result argues against simply doing that, and we are publishing it anyway, because a survey you only report when it flatters your plans is not research.

Almost nobody knows the treatment exists

The second finding explains why the first one is not a contradiction. Seventy-three percent of respondents had never heard of Spravato, the FDA-approved esketamine nasal spray for treatment-resistant depression. Another 21 percent had heard the name but could not say what it was. Six percent knew what it was.

So awareness has genuine work to do. It simply does not do the closing. The honest model is a relay: public information creates recognition, and a physician converts it. Skip the second leg and the first one is wasted spend.

The language gap reinforces it. We asked, in an open text box, what exact words people would type into Google if they were looking for help. Three hundred nineteen people answered, and they typed symptoms and pleas, not pharmacology: "help with depression," "ptsd treatments," "depression medicine alternatives," "therapist near me," "someone please help me." Nobody typed ketamine, Spravato, or TMS.

The need is not niche

Seventy-two percent reported that they or someone close to them had struggled with depression, anxiety, or PTSD that did not improve on standard medication. Combining the 37 percent who said it was them and the 13 percent who said both, 50 percent had lived it personally.

That number deserves a pause. In a general-population sample, nearly three in four respondents have direct contact with depression that standard care did not resolve. Treatment-resistant depression is often discussed as an edge case. In this sample it was closer to the norm.

Coverage is the other lever

If the doctor is the closer, insurance is the gate. Asked to pick the two things that matter most when choosing a provider, 85 percent selected "covered by insurance," far ahead of "close to home" at 43 percent. Sixty-five percent said insurance coverage was the deciding factor or a big factor in whether they would try the treatment at all.

We also offered a direct tradeoff: option A, covered by insurance but with more hoops to jump through, or option B, pay yourself and start faster. Fifty-one percent chose the hoops. Twenty-three percent chose paying themselves, and 26 percent were unsure. Half of this market will accept real friction in exchange for coverage.

The payer mix behind that preference came out close to an even split at the top. Commercial or private insurance came in first at 39 percent, with Medicaid a close second at 37 percent, then Medicare at 23 percent, the uninsured at 9 percent, and TRICARE at 5 percent. Neither of the two big payers is a side case here. A clinic that plans around only one of them is overlooking a group of nearly the same size.

Open, not hostile

Asked for a first reaction to the phrase "ketamine therapy for depression or PTSD," 34 percent were cautious but open and 18 percent were hopeful or curious. Twenty-one percent were skeptical, 18 percent had never heard of it, and 9 percent were negative.

Fifty-one percent open, nine percent firmly against. The work in this category is converting the cautious majority, not arguing with a small hostile minority. What converts them appears to be trust signals rather than enthusiasm: 59 percent said FDA approval was a deciding or big factor.

What this means for clinics, ours included

Four things follow from this data:

• Build the referral path before the ad budget. Physician outreach and a one-page summary a patient can hand their own doctor will out-convert media spend, because the doctor is who they are going to ask anyway.
• Credential commercial plans and Medicaid from day one. In this market they are nearly tied, and neither can wait for a later phase.
• Lead with coverage, FDA approval, and proximity. Those are the three attributes people named. A headline built on the drug name speaks to a word 73 percent of people have never heard.
• Write in symptoms. People search for how they feel and for help, never for a molecule.

A necessary word of caution

This is market research about how people choose care. It is not clinical evidence and nothing here should be read as medical advice. Esketamine, sold as Spravato, is FDA-approved for treatment-resistant depression and is administered under supervision in a certified setting. Whether any treatment is appropriate for you is a question for a clinician who knows your history.

If your depression has ever turned into thoughts of not being here, please tell someone today. In the United States you can call or text 988 at any hour to reach the Suicide and Crisis Lifeline. Reaching out is a sign of strength, and help is available right now.

Methodology

Fielded on the Pollfish consumer panel, closing June 23, 2026. n=443 completed responses. Adults 18 to 64 across ten Midwest states: Missouri, Illinois, Iowa, Nebraska, Kansas, Oklahoma, Indiana, Ohio, Wisconsin, and Minnesota. All respondents passed a consent screener. Figures are final, from the validated respondent export, and are unweighted shares rounded to whole percents. Multi-select questions are reported as a percentage of respondents, so they total more than 100 percent. Brain Recovery Centers commissioned and paid for this study. The full question-by-question results, with raw counts, group breakdowns, and this methodology, are published on our Midwest Depression Care Survey 2026 research page.