You took the pills as prescribed. You waited the weeks it takes. You switched when the first one did nothing and again when the second made you feel flat. And you are still here, still struggling, wondering who you are supposed to ask now.
This FAQ answers that question and the ones that usually follow. Where it helps, it leans on a ten-state Midwest poll we funded, 443 respondents strong, whose final, validated figures describe how people approach care, not medical outcomes.
Is it unusual that my antidepressants have not worked?
No. In our poll, 72 percent had met this problem up close, in themselves, a loved one, or both: depression, anxiety, or PTSD that ordinary medication did not improve. Half, 50 percent, said it had happened to them directly.
That is not a medical statistic about how often antidepressants fail. It is a picture of how many people have lived close to this experience. You are far from alone.
Who do most people ask next?
Their primary care doctor. For a first step toward something like ketamine or esketamine, 56 percent of respondents picked primary care and 23 percent psychiatry; 12 percent would go online by themselves, and 5 percent had no starting point in mind.
Should I go to my primary doctor or straight to a psychiatrist?
Either can be right. A primary doctor usually knows your history, can see you sooner, can check for physical factors, and can start a referral. A psychiatrist can do a more specialized evaluation and offer a wider range of options, but new patient waits are often long and some plans require a referral first.
Many people do both: see the primary doctor to get things moving and get on a psychiatry waitlist at the same time.
Treatment-resistant depression: what does the label mean?
Clinicians generally use it after at least two antidepressants, each given a real chance at a real dose, have failed to bring enough improvement. The label is not a judgment of you. It is a signal to your care team that a different approach may be worth considering. Your clinician decides whether the term applies to you.
What options exist beyond antidepressants?
Your clinician can walk you through what fits your situation. Commonly discussed options include:
- Adjusting or combining medications, such as pairing an antidepressant with a second drug.
- Psychotherapy, alone or alongside medication.
- TMS, or transcranial magnetic stimulation, a magnetic-pulse treatment, FDA-cleared, with no drug involved.
- Esketamine nasal spray, marketed as Spravato; approved for depression that stayed stubborn through earlier medicines, and used only at certified sites.
- Electroconvulsive therapy (ECT), a long-established treatment for severe depression, given under anesthesia.
I have never heard of Spravato. Should I have?
Almost nobody has. In our poll, it was unknown to 73 percent, a bare name to 21 percent, and familiar to 6 percent. Asking needs no vocabulary; "My medications have not worked, so what else is there?" is enough.
Is Spravato the same as the ketamine I have seen advertised?
No, and this distinction is important. Spravato is esketamine in a nasal spray with FDA approval for specific uses, taken only at certified sites where staff observe you after every dose; for a fuller picture, Brain Recovery Centers covers how Spravato treatment works in more detail. Infused IV ketamine for depression is an anesthetic used off-label. Ketamine mailed out by online services has much less supervision and sits in a grayer area. They are not interchangeable.
What about drug-free options? I am tired of medication.
That is a common feeling; 64 percent of our respondents valued a drug-free choice, though a mere 25 percent recognized TMS. If avoiding more medication matters to you, say so clearly. It helps your clinician narrow the options.
Will insurance cover what comes next?
That varies by plan and by treatment. Coverage is on almost everyone's mind, though: 65 percent of respondents said insurance would weigh big or decisively on trying something like esketamine. Many plans require prior authorization, usually showing what you have already tried. Keeping a record of your past medications makes that step easier.
I really do not know where to start. What is the smallest first step?
Five percent of respondents felt the same way. The smallest step is a phone call:
- With a primary doctor already, phone the office and book a visit about depression alone.
- Without one, ring your insurer and ask for an in-network family doctor close by.
- If you have no insurance, look for a community health center, which offers care regardless of ability to pay.
What should I bring to the appointment?
- Your antidepressant history: names, rough dates, doses if known, and results.
- Any other medications and supplements.
- A few notes on how depression is affecting your sleep, work, relationships, and energy.
- Your insurance information.
Is the doctor really the best person to ask?
For most people, yes. In our poll, 74 percent would act on their own doctor's recommendation, and 2 percent on an ad. Your clinician knows your history and can judge what fits you, which no article, including this one, can do.
A note on scope
Consider this FAQ background reading rather than medical advice. Our poll was conducted in the Midwest, and its figures describe that sample, though the questions it raises apply anywhere. Only a clinician can decide whether a given treatment is right for you.
Thoughts of suicide mean reaching out tonight, not after the next appointment. From any state, text or phone 988; counselors at the Suicide and Crisis Lifeline pick up on every day of the year, at any hour.
Methodology
Pollfish administered survey 395586438 to consumer-panel members until June 23, 2026, collecting 443 completes; those answering were 18 to 64 and lived across Kansas, Illinois, Nebraska, Missouri, Iowa, Indiana, Minnesota, Ohio, Oklahoma and Wisconsin. We report validated whole-sample figures. This article's publisher commissioned and financed the survey.