You have watched the pill bottles change. A new name, a higher dose, another six weeks of waiting to see if anything shifts. And the person you love is still on the couch at two in the afternoon, still saying they are fine, still not fine.
If that is your kitchen table in O'Fallon right now, you are in far larger company than it feels like. This FAQ is for the person standing next to the patient: the spouse, the parent, the adult child, the friend who drives to appointments.
Is it unusual for depression to keep going after medication?
Less unusual than most families assume. Earlier this year we paid for a 443-person survey across the Midwest, and one question covered depression, anxiety, or PTSD that stayed stubborn through standard medication, in the respondent or someone close.
Nearly three out of every four said yes: 72 percent. Just 28 percent had no such experience.
Those were everyday adults rather than patients, and in the final validated figures the pattern is hard to miss.
How many were in my position, caring for someone else?
The survey split the answer into parts. Thirty-seven percent said it was their own struggle, 22 percent pointed to someone close, and 13 percent had lived it and watched it in someone they love.
Add the second and third groups together and you get more than a third of respondents who have stood where you stand, beside someone whose treatment stalled. One in three is not a rare club.
Does "the medicine did not work" mean they are beyond help?
No. It means the first approaches did not do enough, a medical fact rather than a verdict. Clinicians tend to reach for the label treatment-resistant depression once a second properly dosed, properly timed antidepressant has also fallen short. The word describes the illness, not anyone's effort.
Next steps range from adjusting or combining medications to structured therapy, TMS, or esketamine. Only a clinician can say which fits; your job is to help the right conversation happen.
Is esketamine the same as the ketamine advertised online?
They are related but not the same, and the difference matters. Esketamine, the Spravato brand, is a nasal spray with FDA approval covering adults whose depression has resisted treatment. Doses happen inside certified clinics, and the patient is watched for a while afterward. They cannot drive themselves home that day, which is where caregivers often come in. This overview of Spravato treatment goes into more detail.
At-home ketamine from telehealth companies is a different arrangement: generic ketamine prescribed off-label, without the supervised setting. It is a grayer area with different safeguards.
Why does it seem like nobody told us about this?
Because few people have heard of it. To 73 percent of the people who answered, the name Spravato meant nothing; just 6 percent could have explained it to a friend. If nobody mentioned it after several antidepressants, that silence is common, not suspicious.
Who should we talk to first?
Begin with the doctor your loved one already sees. Most respondents would: 56 percent named a primary care doctor as the first place they would go for this kind of treatment, and 23 percent a psychiatrist. When it came to persuasion, their own doctor's recommendation won by a mile at 74 percent, with ads managing 2 percent and podcasters just 1 percent.
You do not need to become an expert, just to get your person in front of a clinician they trust.
How do I bring it up without taking over?
A few approaches land better than a lecture:
- Ask permission first. "Can I come to your next appointment? I can take notes so you do not have to."
- Describe what you see, not what you conclude. "You have been sleeping until noon for a month" lands differently than "you are depressed again."
- Offer to write down the history, medication by medication. Depression makes that timeline hard to recall.
- Let them own the question. "Would you want to ask the doctor what comes after these meds?" keeps the decision theirs.
What should we ask at the appointment?
- Based on the medications tried so far, would this count as treatment-resistant depression?
- What are the next options, and which ones make sense here?
- Is esketamine something to consider, and if not, why not?
- If a referral is needed, who in the St. Charles County area do you send people to?
- What will insurance likely require before any of this is approved?
Will insurance cover it?
It depends on the plan, and it is worth asking early. Coverage weighed heavily in our survey. Eighty-five percent named "covered by insurance" among their two top priorities in a provider, and just over half would take on more hoops if that kept the treatment covered. Plans that cover esketamine commonly require documentation of earlier medication trials, which is one more reason your written timeline helps.
Is there anything local about O'Fallon that matters here?
Mostly geography. O'Fallon sits in a fast-growing stretch of St. Charles County where many families commute, and a treatment with frequent early visits and a mandatory ride home adds up. Closeness to home ranked second in our survey, chosen by 43 percent. Map the drive and settle who handles transportation before you commit.
What about me?
Caregiving through stubborn depression is exhausting. Your own doctor, a support group, or a counselor of your own are fair places to say so.
If you ever notice your loved one talking about not wanting to be here, giving things away, or saying goodbye in ways that feel off, act before the next appointment. The Suicide and Crisis Lifeline takes 988 calls and texts at every hour, whether you are calling for them or for yourself, and veterans can press 1. Someone will pick up.
Methodology
This article uses our survey on the Pollfish consumer panel, open until June 23, 2026, with 443 people answering, all adults 18 to 64, from Iowa, Kansas, Oklahoma, Nebraska, Minnesota, Wisconsin, Missouri, Illinois, Indiana, and Ohio. We report top-line figures, all of them from Pollfish's validated final data. Multi-select items can total more than the sample itself. This site's publisher commissioned the survey and covered its full cost. Nothing here is medical advice; suitability is a clinician's call.