Readers in St. Charles County who are wary of ketamine therapy tend to ask us the same pointed questions. Most of them circle back to one issue: what, exactly, has the FDA signed off on? Here are our answers, as direct as we can make them.
Our answers rest on a summer poll we funded, 443 adults in Missouri and nine neighboring states, along with public information on each treatment. The poll numbers are final whole-sample totals. None of this is medical advice.
Am I the only one around here who is suspicious of ketamine therapy?
Far from it. Our poll put "ketamine therapy for depression or PTSD" to respondents and asked for a gut reaction. Skeptical was the pick for 21 percent, just over a fifth, while 9 percent went negative. Another 34 percent said cautious but open. Only 18 percent were hopeful or curious. Wariness is the norm, not the exception.
Does FDA approval matter to people, or is that just me?
It matters to most people. In our poll, 19 percent said FDA approval would decide the question outright and 40 percent called it big, so 59 percent weigh it heavily. A mere 14 percent gave it no weight.
This FAQ does not break out how skeptics in particular answered; these are everyone's numbers.
Is any form of ketamine FDA-approved for depression?
One. Spravato, the brand name of esketamine, is the spray the FDA signed off on for adults stuck with depression after other antidepressants fell short. Generic ketamine is approved as an anesthetic, so when a clinic uses it by IV for depression, that is off-label. At-home ketamine is off-label as well, and some of it is compounded.
Why haven't I heard of Spravato?
You are in the majority. In our St. Charles and Midwest poll, 73 percent were equally unfamiliar, and one in five knew the name without any idea what it is, leaving 6 percent able to describe it.
If it's approved, why can't I take it at home?
Because the approval came with a safety program. Spravato can only be given at certified healthcare sites. You spray it yourself while staff watch, then wait under observation a couple of hours or more, and someone else drives you home. Brain Recovery Centers explains what happens during Spravato treatment in plain terms. The rules exist because of known risks, including sedation, dissociation, raised blood pressure, and potential misuse.
Does that mean it's dangerous?
It means it has risks serious enough that the FDA required they be managed on every dose. Whether those risks are acceptable for you depends on your health history, which a clinician needs to review. Some people are not good candidates.
A clinic near me advertises "FDA-approved ketamine." What does that mean?
Ask them. Specifically: "Which product do you use, what is it approved for, and is my use on-label?" If they offer Spravato, confirm certification using the treatment center finder on the drugmaker's site. If they offer IV infusions or at-home products, those are off-label uses. The FDA does not approve clinics, only products.
How do I check the provider's credentials?
Missouri's Board of Registration for the Healing Arts has a public license lookup for physicians. Search the supervising clinician's name and confirm the license is active. For telehealth prescribers, make sure they are licensed in Missouri.
Will my insurance cover the approved version?
Often, but usually after prior authorization, and plans typically want records showing you tried other antidepressants first. Call the number on your card. If you are on MO HealthNet, ask which certified sites are in network.
You would not be alone in putting cost first. Choosing two provider priorities, 85 percent of respondents picked insurance. And half would put up with insurance hoops before paying cash for a quicker start.
What about getting there from St. Charles County?
Plan for it. Because you cannot drive after a dose, every visit needs a ride home. A certified site on the St. Louis County side of the Missouri River means I-70 or Page Avenue traffic and a driver who can spare the afternoon. Our respondents cared about this too; 43 percent put a nearby provider among their two priorities.
Is there something FDA-reviewed that isn't a drug?
Yes. TMS, short for transcranial magnetic stimulation, sends pulses from a coil on the scalp and uses no medication. Those devices are FDA-cleared for adults whose major depression persisted despite antidepressants. "Cleared" is the FDA's term for many devices reviewed through its device pathway. Among our respondents, 64 percent valued a drug-free choice, but only 25 percent had heard of TMS.
Should I trust my doctor on this?
Most people do. For 74 percent of our respondents, the push would come from their own doctor recommending it, and 56 percent would start by asking primary care. Skeptical questions are welcome in that conversation. You might start with: "I'm wary of ketamine. What exactly would you suggest, and what is its FDA status?"
Can I just stop my current antidepressant while I figure this out?
Please do not do that without your prescriber. Stopping suddenly can cause withdrawal and bring symptoms back.
What if I look into all of this and still say no?
That is a legitimate decision. Being skeptical after you have the facts is not the same as refusing help. Ask about other options, including therapy and TMS, and keep the conversation going with your clinician.
And if tonight is the hard part?
Then set the FDA questions down. From O'Fallon, St. Peters, or anywhere else, the three digits 988 reach a Suicide and Crisis Lifeline counselor, by phone or by text, free and confidential at any hour.
Methodology
Pollfish study 395586438 recruited through the company's consumer panel; by its June 23, 2026 close it held 443 responses from people 18 to 64 in Missouri, Ohio, Wisconsin, Iowa, Nebraska, Illinois, Indiana, Oklahoma, Kansas and Minnesota. Every participant cleared a consent screener. For multi-select questions, a percentage is the fraction of all respondents picking that answer. The totals are validated and final. The publisher commissioned and paid for this work.