There is a particular silence in the car on the way to a follow-up appointment when the medication has not worked. Your wife is looking out the window. You are both rehearsing how to say "it is not better" without it sounding like a complaint, or like giving up.
This script is for caregivers in St. Charles County who need to tell a doctor that standard depression treatment has not done enough, and ask what comes next. It leans on what 443 Midwest adults told a survey we ran. Numbers reflect the whole ten-state sample, in the final form Pollfish validated.
Why saying it clearly matters
You are in large company. Our survey found 72 percent had met depression, anxiety, or PTSD that standard pills did not relieve, whether their own, someone else's, or both. Someone close accounted for 22 percent, and both applied to 13 percent.
Yet many people never say the words "it is not working" plainly in an appointment. They say "a little better, I guess" and leave with the same prescription. A clear statement of what has and has not changed is what lets a doctor consider whether the depression is treatment-resistant, and that label opens a different set of options.
Your role matters too. A close friend or family member was the most persuasive voice for 18 percent of respondents, behind only their own doctor at 74 percent. You are not the decision-maker. You are the person who helps the decision happen.
Before the visit: two conversations at home
With your loved one. Ask permission to speak up. Something like: "Would it be okay if I help explain how things have been? I will let you go first." If they want you in the room, the office may ask them to sign a form allowing the doctor to discuss their care with you.
With a notepad. Write down every medication tried, any dose you can find, the length of each trial, and the result. Then write three concrete examples of how depression shows up now. "Has not been to her book club since March." "Sleeps eleven hours and is still exhausted." "Stopped cooking, which she loved."
Opening: let them speak, then add
Let your loved one start. If they minimize, you can gently add:
"Can I add something? From where I sit, the medication has not made much difference. She is still not sleeping well, she has stopped seeing friends, and she told me last week she feels like nothing is going to change."
Laying out the history
"Here is what she has tried. The first medication she took for about three months at the dose on this list. The second one for about two months, and the dose was raised once. Neither made a real difference."
Hand over the written list. Doctors think about adequate dose and duration when considering treatment-resistant depression, and your list answers those questions before they are asked.
Asking the key question
"With the medications she has been through, does this look like treatment-resistant depression to you? And if so, what options does that open up?"
You do not need to know what the options are. Most people do not. Spravato, an esketamine spray given for treatment-resistant depression, left 73 percent of the adults we surveyed shrugging. It is perfectly fine to say, "We do not really know what else is out there."
Asking about specific options, if they come up
If the doctor mentions esketamine:
"Is that the FDA-approved nasal spray? Where would she get it, how often, and what happens during a session?"
Esketamine is given at certified clinics, where the patient is monitored for a period after each session and has to skip driving until the next day. Approval matters to many people: FDA approval would be decisive, or weigh heavily, for 59 percent of respondents. That sets it apart from off-label IV ketamine and from the at-home ketamine services advertised online. If you want to read ahead, this Spravato explainer for caregivers walks through a typical visit.
If your loved one would rather avoid another medication:
"Are there options that do not involve medication?"
That preference is common. Nearly two in three of the people we asked, 64 percent, said avoiding medication would count for something in their choice. The doctor may discuss therapy changes or TMS.
Asking about coverage and the drive
Eighty-five percent of respondents listed coverage in their top two, and 43 percent listed closeness to home. In St. Charles County, both questions are practical ones.
- "Does our insurance usually cover this, and will it need approval first?"
- "Can you send her medication history with the referral?"
- "Is there a clinic in the county, or would we be driving into St. Louis?"
- "How often would I need to bring her in at the start?"
If your household is on MO HealthNet, ask the office whether the clinic accepts her specific managed care plan.
If your loved one is hesitant
Many people are. Twenty-one percent of respondents first reacted to ketamine therapy with doubt, and 34 percent called themselves cautious but open. If your loved one is unsure, say so on their behalf: "She is nervous about trying something new. Can you tell us about the risks?" Then let them decide.
Closing the appointment
"So what are the next steps, and who will call us? If we do not hear anything in a week, who should we contact?"
Write it all down before you leave the parking lot.
When it is more than frustration
If your loved one has spoken about suicide, tell the doctor at the start of the appointment. If you are worried before the appointment, the Suicide and Crisis Lifeline can help at any hour, including with advice on supporting someone else. Text or dial 988; veterans can press 1. With immediate danger, call 911.
A limit on this script
This is a communication guide built from survey data rather than medical advice. The treatment that suits your loved one, if any, is for their own clinician to judge.
Methodology
The survey went out through Pollfish's consumer panel, wrapped up June 23, 2026, and counted 443 respondents, ages 18 to 64, spread over Illinois, Kansas, Minnesota, Missouri, Iowa, Nebraska, Indiana, Oklahoma, Ohio, and Wisconsin. We cite no county-level figures; percentages are ten-state top-line, from the panel's completed validation. The publisher commissioned the survey and absorbed its cost.