Picture three ways a patient with stubborn depression might first hear about esketamine: a television spot during the evening news, a sister who read something online and raises it at Sunday dinner, or a family physician who says near the end of a routine visit, "There is something we have not tried yet."
Which one gets the patient to a treatment chair? We put that question, in effect, to 443 people across a ten-state Midwest panel, and the answer ranks these channels more starkly than we expected. This comparison is for the physicians and other referrers who sit in the third scenario. Every figure is final.
The scoreboard
Asked whose recommendation would most make them try ketamine or esketamine therapy, respondents ranked their own doctor first at 74 percent. Relatives and close friends took second place with 18 percent, then a uniformed influencer at 4 percent, an advertisement at 2 percent, and a trusted podcast host at 1 percent. The physician outdrew every other voice combined by a wide margin; advertising and podcasts together came to 4 percent.
Channel one: the advertisement
What it does well: reach. An ad can put a name before thousands who have never heard it, and awareness is genuinely low; in our sample, 73 percent had never encountered the name Spravato and another 21 percent knew only the name.
Where it falls short: persuasion. An ad was the pick of just 2 percent of respondents, which fits how they search: the 319 people who answered our search question wrote things like "help with depression" and "therapist near me," and essentially no one typed a brand, so even a memorable ad may not carry someone to the right search.
What it means for you: a patient who mentions an ad is asking you to translate it, not reporting a decision.
Channel two: friends and family
What it does well: trust and persistence. At 18 percent this was the clear runner-up, and family members often notice first when a medication stops working. A spouse who drives to appointments has influence a stranger never will.
Where it falls short: accuracy. A relative who read about ketamine may be describing an IV clinic, an at-home telehealth product, or esketamine without knowing the difference. Esketamine's FDA approval covers treatment-resistant depression and requires supervised dosing at a certified site; IV ketamine in a clinic is prescribed off label; and home ketamine products fall looser still.
What it means for you: family can help with follow-through. A plain one-page summary the patient can share at home extends your recommendation to the second most trusted voice in their life, and Brain Recovery Centers publishes Spravato information for families and patients of the kind a household can read together.
Channel three: online figures and podcasts
What it does well: identification. Veterans and first responders who speak publicly about their own treatment can ease stigma for people who share their background.
Where it falls short: in this sample, conversion, with online service figures at 4 percent and podcast hosts at 1. Those shares may matter more in particular communities, but this comparison uses top-line results only, so it cannot say by how much.
What it means for you: a patient who cites a public figure has probably been thinking about this a while. Treat it as an opening, not a conclusion.
Channel four: the physician
What it does well: nearly everything that matters. At 74 percent, a patient's own doctor dominated, and a second question agreed: for a first stop, 56 percent would go to their primary doctor, 23 percent to psychiatry or another mental health clinician, and 12 percent to their own online research.
Where it falls short: time and information. A short visit leaves little room to explain a supervised nasal spray, certification, monitoring after each dose, and prior authorization, and physicians may not know which nearby sites take which insurance.
What it means for you: your recommendation carries weight no other channel matches, but it lands better with logistics attached. A name without a place and a coverage plan can stall.
Why logistics decide whether the recommendation sticks
Respondents were clear about what comes next. Asked for their top two provider priorities, 85 percent picked insurance and 43 percent nearness to home, while about a quarter each chose fast results and FDA approval, though separately 59 percent treated FDA approval as deciding or a big factor. Coverage could be the whole decision, or most of it, for 65 percent, and half would rather go through insurance with extra steps than pay to start faster.
The payer picture was broad: commercial insurance was checked by 39 percent and Medicaid by 37, while 23 percent chose Medicare, 5 percent TRICARE, and 9 percent reported being uninsured; more than one answer was allowed.
A comparison checklist for your office
- Identify the nearest certified sites and note which take Medicaid, Medicare, and major commercial plans in your state.
- Prepare a short handout that names the treatment, explains supervised administration, and lists local sites. It travels to the family, the second strongest channel.
- Use the patient's words. They talk about needing "help with depression," not molecules. Meet them there, then introduce the name.
- Be clear about categories. Approved esketamine, off-label IV ketamine, and at-home products are not one thing.
- Leave suitability to clinical judgment. The survey describes preferences, not who is a good candidate.
The limits of this comparison
This is a stated-preference survey. People are not always accurate about what will move them, and a general panel is not a clinic population. This comparison reports whole-sample figures, not breakdowns by age, payer, or state, so it cannot say which channel works best for a particular group. Across every question touching on trust, though, the same answer kept surfacing.
If you or someone you care for is thinking about suicide, 988 answers calls and texts at every hour, and reaching out is a step toward safety, not a sign of failure.
Methodology
Funding for the study came from the publisher, which also commissioned it. Pollfish handled fieldwork, which ended June 23, 2026, collecting 443 complete surveys from consenting residents of ten Midwest states between ages 18 and 64. Some multi-select totals top 100 because each option is counted against all respondents.