Referral habits tend to form early in a career and then run on autopilot. Some of the assumptions baked into them were never tested. Our commissioned survey of 443 Midwest adults set out to learn how people find and choose depression care, and several of its findings cut against beliefs we hear often from primary care and other referrers.
Here are the most common ones, checked against the data. Every figure is top-line and has passed final validation.
Myth 1: "Depression that does not respond to medication is a small corner of my panel."
What the survey found: Respondents said whether depression, anxiety, or PTSD had held out against standard medication in their lives or in someone close to them, and 72 percent said it had. For 37 percent it was theirs alone; another 13 percent had faced it themselves and also beside someone close.
The fair reading: This is self-report in a general-population panel, with a broad question, so it is not a prevalence estimate for treatment-resistant depression as clinically defined. But it is hard to square with the idea that stalled treatment is rare. The patient experience of "it did not work" appears to be the majority experience in this sample, which suggests it is under-recognized in routine follow-up.
Myth 2: "If patients want something more, they will ask for it."
What the survey found: They mostly cannot ask, because they do not know what to ask for. Just 6 percent of respondents could say what Spravato was, and nearly three quarters had never heard the name. Awareness of TMS reached only about a quarter of the sample.
In an open-text question, 319 people described what they would search for help, with phrases such as "how to cope with my anxiety" and never a drug name. The demand is real. The vocabulary is missing.
Myth 3: "Patients get their treatment ideas from ads and the internet now."
What the survey found: On who could best talk them into a new depression treatment, respondents gave 74 percent to their own doctor. Word from a friend or relative came a distant second, at 18 percent. Ads pulled 2 percent; podcast hosts, 1 percent.
Primary care was the opening choice of 56 percent, psychiatry of 23 percent. Online searching came in at 12 percent. The referrer is not a formality at the end of a consumer journey. For most people, the referrer is the journey.
Myth 4: "People around here are hostile to anything ketamine-related."
What the survey found: When respondents first heard the phrase ketamine therapy, their reactions leaned cautious, not hostile. The largest group, 34 percent, called themselves cautious but open. Hopeful or curious was 18 percent. Skeptical was 21 percent. Only 9 percent were negative.
The fair reading: Caution is appropriate, and clinicians should welcome it. But a referrer who avoids the topic to spare patients discomfort may be misjudging the room. When raising esketamine, keep the distinction clear: its FDA approval applies to adults whose depression has resisted treatment, and delivery happens only at sites certified to give Spravato, while off-label ketamine, including at-home programs, is a separate category with less oversight. A plain-language Spravato page for patients can support that conversation.
Myth 5: "Patients will not put up with prior authorization."
What the survey found: Given covered care with more hoops or simpler self-pay, just over half of respondents took the covered route. Only 23 percent preferred self-pay, with the remaining 26 percent unsure. Coverage was among the top two for 85 percent, and 65 percent called it deciding or big in trying treatment at all.
Patients will tolerate friction if it leads to covered care. What they need is someone to explain the friction and help document the medication history payers ask for.
Myth 6: "My patients are mostly commercially insured, so that is the network I need."
What the survey found: Commercial coverage was the most common plan respondents reported, at 39 percent, but Medicaid was nearly tied at 37 percent, with Medicare at 23 percent and 9 percent uninsured. Commercial may be the single largest group, yet a network built only on it would miss a large share of patients. Across the Midwest, a referral network built only around commercial plans misses a large share of the population.
Your own panel may differ. The point is to check rather than assume.
Myth 7: "People would rather do this from home now."
What the survey found: In-person clinic care was the most chosen delivery format, the choice of 44 percent. A clinic-first hybrid drew 23 percent and home telehealth 22 percent, with 11 percent indifferent. Combining the first and third options, two-thirds of respondents wanted a physical clinic in the plan somewhere.
Esketamine requires in-clinic administration anyway. For other options, do not assume convenience trumps the reassurance of a physical site.
Myth 8: "Patients care about speed above all."
What the survey found: Fast results made the top two for 24 percent of respondents, a little below FDA approval at 27 percent, and well behind insurance and being close to home. For a Midwest patient base where specialized centers may be an hour or more away, distance often matters more than how quickly a treatment works.
What to change on Monday
- Ask about treatment response at every depression follow-up, with a standardized measure.
- Document each antidepressant trial in a way a payer can read.
- After two inadequate trials, name the situation and describe the next options, even if the patient does not ask.
- Know at least one referral destination for each major payer your patients carry.
- Separate FDA-approved esketamine from off-label ketamine in every conversation.
Put crisis resources in writing for every patient with depression. The Suicide and Crisis Lifeline answers anyone in the country who calls or texts 988 at any hour, with a press-1 option for veterans. A printed reminder on the after-visit summary is a small act that can carry a patient through a bad night.
Methodology
Our survey went out on Pollfish's consumer panel and had collected 443 completed responses by the time it wrapped up on June 23, 2026. Those adults were 18 to 64 and lived in Wisconsin, Indiana, Nebraska, Illinois, Oklahoma, Minnesota, Kansas, Missouri, Ohio, and Iowa. We cite top-line percentages only, and the figures come from the validated final responses. The publisher commissioned the survey and paid for it from its own budget. This is market research, not clinical evidence.