You have been on your third antidepressant for two months. The pharmacy in O'Fallon knows your name. Your MO HealthNet card is in your wallet, and you still feel like you are wading through wet cement every morning. Nobody has mentioned that there is an FDA-approved treatment built for exactly this situation. You would not know to ask about it, because you have never heard its name.
If that sounds familiar, you are in very large company. That is the story our survey told.
The number that frames everything else
In June 2026 our paid survey reached 443 Midwest adults aged 18 to 64, Missourians among them, and asked about Spravato, an esketamine nasal spray. Nearly three out of four, 73 percent, did not know it existed; 21 percent knew the word but not its meaning, and just 6 percent could explain it.
Put those first two groups together and 94 percent, combined, could not have described it. That is no personal failing; the treatment is given only in certified settings and rarely advertised.
The figures are final, from the validated data.
Why this matters more if you are on Medicaid
The final data breaks out the 163 respondents on Medicaid. Of that group, 69 percent had never heard of Spravato, a little under the sample overall, so the gap is nearly as wide for enrollees. Medicaid was also one of the two biggest payer groups, at 37 percent, close behind employer or private insurance at 39 percent.
When few people know a treatment exists, the clinician becomes the only route to hearing about it. If the clinician does not raise it, the option stays invisible.
Coverage was also what people cared about most: 85 percent of respondents counted "covered by insurance" as a top-two provider factor, with closeness to home next at 43 percent. For someone in O'Fallon, those two concerns usually arrive together: can I get this paid for, and can I get there without losing a whole day?
What esketamine is, briefly
Esketamine is a nasal spray with two FDA-approved uses in adults: treatment-resistant depression, which usually means at least two proper antidepressant trials came up short, and major depression in which acute suicidal thoughts or behavior appear, alongside other care.
You never take it home. The spray is self-administered inside a certified treatment center, where staff keep an eye on you for two hours or longer because sleepiness, dissociation, and a blood pressure rise can follow, and you may not drive until the next day. Whether it suits you depends on your history and current medications, and deciding that is a clinician's job.
It is also different from ketamine sold by cash-pay clinics or mailed by online companies, which is off-label for depression and overseen differently.
Where people said they would start
The survey hints at how the gap closes. Fifty-six percent of respondents would start in primary care, 23 percent in psychiatry, and 12 percent with their own online research, while 5 percent had nowhere in mind. On what would get them to try it, a doctor's word dwarfed everything: 74 percent picked their own doctor, and ads drew 2 percent. For Medicaid enrollees the figure was 75 percent.
So the path runs through the exam room, not the billboard on Highway K, and a MO HealthNet member in O'Fallon already has a primary care provider assigned through the health plan.
Practical steps for O'Fallon MO HealthNet members
- Find your plan. Most MO HealthNet members get care through a managed care health plan. The name and a member services number are printed on your card. That number can confirm whether esketamine requires prior authorization and which nearby centers are in network.
- Write down your medication history. Note each antidepressant, its dose, how many weeks you gave it, and why it ended. Coverage often hinges on that record, and your pharmacy can print your prescription history if memory fails.
- Book a visit that is only about your mood. Do not tack it onto a knee appointment.
- Say the name. "I read about esketamine, sold as Spravato, for treatment-resistant depression. Could I be a candidate, and if not, why not?" Asking by name is how you move out of the combined 94 percent of respondents who had never heard of it or knew only the name, and into the 6 percent. A short Spravato overview can help you prepare.
- Plan the ride. Early treatment often means two sessions a week with no driving afterward, so ask your plan whether its non-emergency medical transportation benefit covers certified-center trips and can wait out a two-hour observation. If not, line up a friend or relative.
- Keep your coverage active. Answer Medicaid renewal notices quickly; a lapse mid-course can stall everything.
A local note
O'Fallon keeps growing, yet much specialty mental health care still sits closer to the city and in St. Louis County. Ask any treatment center about distance and appointment times; 40 minutes each way at rush hour, twice weekly, adds up fast.
The honest limits of this story
This is survey research on awareness and decisions, not clinical evidence, and it cannot tell you whether esketamine would help you. It does tell you that not knowing the name is typical, and that most people would find out through a doctor they already see.
If thoughts of ending your life have started showing up, skip the appointment wait. A trained person answers at the Suicide and Crisis Lifeline when you call or text 988 at whatever hour; veterans can press 1.
Methodology
These numbers come from a survey Pollfish carried to its consumer panel members, closing June 23, 2026; 443 adults between 18 and 64 completed it, living in Kansas, Iowa, Illinois, Missouri, Oklahoma, Minnesota, Nebraska, Wisconsin, Indiana, and Ohio. We report whole-sample results plus the Medicaid breakdown above. Multi-select questions, including insurance type, can total more than the sample, and each figure stands as validated and final. The publisher of this site ordered the study and covered its cost.