Once you decide your depression needs a new approach, the next decision arrives fast: who do you actually call? For most adults, the realistic choices come down to three. Your primary care doctor. A psychiatrist you see in person. Or a psychiatrist or psychiatric nurse practitioner you meet by video.
Each can be a good first stop, for different reasons. Below they are compared, with context from a ten-state Midwest poll we funded that reached 443 adults. Its figures are final after Pollfish's validation.
The first-stop numbers
When our respondents imagined pursuing ketamine or esketamine for depression, 56 percent would begin with the family doctor, 23 percent a psychiatrist, and about one in eight, 12 percent, a search on their own.
Our survey did not break psychiatry into in-person and video visits, so the split between the second and third options below is not something we measured. But we did ask how people would prefer to receive treatment itself, and that tells us something about comfort with each format: in-person clinic care suited 44 percent, video care at home 22 percent, starting at a clinic and shifting home afterward 23 percent, while 11 percent voiced no preference.
Option one: your primary care doctor
Best for: Getting started quickly with someone who already knows you.
- Access: Usually the fastest in-person appointment, especially if you are an established patient.
- What they can do: Screen for depression, check for physical contributors such as thyroid or sleep problems, review your medication history, adjust or add medications, and refer you on.
- What they usually cannot do: Provide specialized treatments such as esketamine, which must be given in a certified setting, or manage very complex medication plans over time.
- Trust: High. In our poll, 74 percent said the family doctor is the voice they would follow on this.
- Insurance: Rarely needs prior approval for the visit itself, and the office often holds the records insurers ask for later.
Option two: an in-person psychiatrist
Best for: A thorough specialist evaluation and the widest range of options.
- Access: Often the slowest. New patient waits can be long, and some practices or plans require a referral first.
- What they can do: A detailed diagnostic evaluation, complex medication management, and assessment for treatments like TMS or esketamine. Some psychiatry practices are certified to provide esketamine on site, which can keep evaluation and treatment under one roof.
- What they may not do: Handle general medical issues that could be contributing, which is where your primary doctor still matters.
- Insurance: Check that the psychiatrist is in network and whether a referral is required.
Option three: telepsychiatry
Best for: Getting specialist input when in-person psychiatry is far away or booked up.
- Access: Sometimes faster than in-person psychiatry, particularly in rural areas.
- What they can do: Evaluation, diagnosis, medication management, and recommendations for further care. Many insurance plans cover video visits.
- What they cannot do: Give esketamine through a screen. Each dose happens in person at a certified site, followed by observation. Brain Recovery Centers explains how in-person Spravato treatment works for anyone planning around that. A telepsychiatrist can recommend it and help coordinate, but you will still need a physical location for treatment.
- A caution: Some online companies offering ketamine are not telepsychiatry in the traditional sense. At-home ketamine prescribed after a video visit is off-label and involves far less supervision than an approved in-clinic treatment. Ask exactly what is being offered.
Side by side
- Speed to first visit: primary care usually fastest; telepsychiatry often next; in-person psychiatry often slowest.
- Depth of mental health evaluation: psychiatry, whether in person or by video, goes deepest.
- Physical health check: primary care.
- Can deliver esketamine directly: only a certified in-person setting, which may include some psychiatry practices.
- Holds your full medical history: typically primary care.
What about starting with a search?
The roughly one in eight respondents who would begin online are not wrong to want information, and searching can help you learn what to ask. What it cannot do is evaluate you, check your blood pressure, or document your history for an insurer. It also tends to lump together very different offerings under the single word "ketamine." Treat search as preparation, and bring what you find to whichever clinician you see first.
Which should you pick?
- If you have a primary doctor you trust: Start there, as most respondents said they would. Ask for a psychiatry referral if the depression has not responded to more than one medication.
- If you have no primary doctor: A telepsychiatry service covered by your insurance can get specialist eyes on the problem while you look for primary care.
- If you already have a psychiatry referral: Take the first appointment available, in person or by video, and let that clinician help decide next steps.
- If you live far from specialists: Combine them. Primary care locally, psychiatry by video, and treatment, if recommended, at the nearest certified site.
Whichever you choose, bring the same things
- A list of every antidepressant tried, when, and what happened.
- Other medications and health conditions, especially blood pressure or heart issues.
- Your insurance details. In our poll, coverage topped every other provider priority, picked by 85 percent.
- One clear question: "Standard treatment has let me down, so what comes next?"
Important context
This page compares care routes and offers no medical advice. Spravato, the esketamine brand, has FDA approval for adult depression that earlier care left in place, and a certified clinic oversees each dose; a clinician decides whether it, or anything else, fits you. Our survey sampled the Midwest; these care routes exist nationwide, though availability varies by area.
If suicide has entered your thinking, reach 988 now by voice or text. The Suicide and Crisis Lifeline never closes, and no particular kind of crisis is required to use it.
Methodology
Pollfish study 395586438 went to members of the Pollfish panel through June 23, 2026, and 443 of them, all aged 18 through 64, finished it, living in Ohio, Nebraska, Kansas, Missouri, Indiana, Oklahoma, Minnesota, Iowa, Wisconsin and Illinois. The numbers are whole-sample and final. Funding and the commission for the work came from the publisher.