Picture a couple in O'Fallon, sitting in the car in a grocery store parking lot off Highway K because it is the only private place they could find to talk. One of them has been fighting depression for years. Two medications, then a third, and not much change. The other has been reading late at night and wants to bring up ketamine. The first reaction is a flat "no, that's a party drug." The second is "but what if it's legit?"
Couples get stuck in that exact loop all the time. A survey we commissioned this summer suggests there may be a way out of it, and it is a surprisingly plain one: the FDA label.
What the numbers say about trust
Our survey asked 443 people, all adults and some of them Missourians, something simple: how much would FDA approval count when deciding on a new depression treatment? These are final, validated answers.
Almost one in five, 19 percent, said FDA approval would be the deciding factor. Two in five, 40 percent, said it would be a big factor. Together that is 59 percent of respondents for whom approval really counts. Only 14 percent brushed it off entirely. The 156 people in a veteran's or first responder's family, spouses included, leaned harder on the label: 67 percent of them gave approval that weight.
We also asked respondents for their gut response to ketamine therapy, presented as treatment for depression or PTSD. At 34 percent, cautious but open was the most common answer. Twenty-one percent were skeptical, 18 percent were hopeful or curious, and another 18 percent had never heard of it. Just 9 percent were negative.
Put those two findings side by side and a picture emerges. Most people are not firmly for or against. They are waiting for a reason to trust. For a majority, FDA approval is one of those reasons.
Why the label can help a couple
When one partner is skeptical and the other is hopeful, arguments tend to be about feelings and headlines. "I read that it works." "I heard it's dangerous." Neither side has much to stand on.
An FDA label shifts the conversation to something outside both of you. It is a specific, checkable fact. And in the ketamine family, it draws a clear line:
- Esketamine, sold as Spravato, holds an FDA approval covering depression that has held firm against other medicines. Patients use the nasal spray inside certified clinics and remain under watch for two hours or longer each time. Brain Recovery Centers explains what a Spravato treatment day looks like.
- IV ketamine is approved as an anesthetic, which makes depression care with it off-label.
- At-home ketamine is not FDA-approved for depression.
So the skeptical partner in the parking lot is partly right: not every form of ketamine care has been through the FDA for depression. And the hopeful partner is partly right too: one form has. That is a much more productive place to start than "it's a party drug" versus "it's a miracle."
If avoiding medication altogether matters more to you, the conversation shifts to TMS, a drug-free option the FDA has cleared, as a device, for depression that antidepressants have not shifted.
What the label does not settle
Approval is a strong signal about evidence and oversight. It is not a promise. Your partner may or may not respond, and approval is no statement that everyone can take it safely. It means the FDA judged the benefits to outweigh the risks for a defined group of patients under defined conditions. Whether your partner fits that group is a clinician's call.
Where partners carry weight, and where they don't
Here is the part of the data that tends to humble spouses. We asked whose recommendation would make someone try a new depression treatment. A friend or family member was the answer for 18 percent. Their own doctor was the answer for 74 percent.
So if you are the hopeful partner, the goal is not to win the parking lot argument. It is to agree on one question and bring it to the doctor together:
"Since the pills haven't worked, is there something FDA-approved we should look at, and could it suit my partner?"
That framing respects the skeptic's caution and the hopeful partner's curiosity at the same time. It also puts the recommendation where it will actually be heard.
The O'Fallon logistics
If the answer turns out to be esketamine, logistics come next, and they land squarely on the partner. After each dose, your partner is barred from driving until the following day, after sleeping. Early treatment typically runs twice a week for the first month, then tapers to weekly or less. Every session comes with a monitoring period of two hours or more.
For an O'Fallon household where one or both partners commute on I-64 or I-70, that schedule can mean real rearranging. It is worth asking whether a certified clinic is closer to home or closer to work, and which one makes the twice-weekly drive sustainable. Proximity mattered in our survey too: 43 percent ranked a nearby location among the two things they want most in a provider.
Insurance is the other practical piece. Coverage made the top two for 85 percent of respondents. For an FDA-approved treatment, many plans have a defined approval path, usually prior authorization with a record of the antidepressants already tried. Helping your partner write down that medication history is one of the most concrete ways to help.
Back to the parking lot
The couple in the car do not need to agree on ketamine. They need to agree on the next question, and on who should answer it. The FDA label gives them a fair, shared starting point. The doctor gives them the answer that applies to their life.
This story is general information for O'Fallon couples, not medical advice.
If your partner mentions wanting to die, or you worry they may not be safe tonight, call or text 988 right away. Suicide and Crisis Lifeline counselors are on duty every hour, and worried partners in O'Fallon can use the line too, not only the person who is struggling.
Methodology
This survey, which we commissioned, ran on the Pollfish consumer panel. On June 23, 2026 the survey stopped, having counted 443 finishers aged 18 to 64 from Nebraska, Illinois, Ohio, Oklahoma, Indiana, Minnesota, Iowa, Wisconsin, Kansas, and Missouri. Figures are final, with panel validation complete. The publisher paid for the research.