Spravato treatment for Boca Raton — REMS-certified, insurance-covered TRD care.

RECO Integrated Psychiatry's Delray Beach office is 11 miles — a 20-minute drive up Federal Highway — from Mizner Park, and one of the few Boca-area sites where the same psychiatrist handles the Spravato sessions, the concurrent oral antidepressant, and the insurance authorization. REMS-certified, covered by Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS for documented TRD. Induction sessions are scheduled in blocks to avoid Federal Highway rush hour, and every dose is followed by the two-hour CADSS and blood-pressure monitoring the protocol requires.

From Mizner Park or Royal Palm Place, RECO Integrated Psychiatry’s Delray Beach office is a 20-minute drive up Federal Highway — about 11 miles, shorter than most Boca Raton morning commutes. That matters for Spravato, because the protocol requires two hours of post-dose monitoring twice a week during induction, and treatment only works when the schedule fits an actual life. Adults from Downtown Boca, Boca West, and Highland Beach are seen at the Delray campus by a REMS-certified psychiatry team that handles the esketamine sessions, the concurrent oral antidepressant, and the insurance authorization inside one clinical relationship.

Spravato and the REMS protocol — what treatment actually looks like

Esketamine is delivered as a nasal spray the patient self-administers under nursing supervision — one device per nostril, spaced five minutes apart, at 56 mg for the first session and 84 mg for subsequent sessions. Dose is titrated for tolerability, most commonly when a patient experiences nausea, meaningful sedation, or blood pressure elevation above the REMS thresholds. Because Spravato treatment is delivered under a federal Risk Evaluation and Mitigation Strategy, every session is documented in the SPRAVATO REMS registry by the office rather than by the patient.

Two hours of in-office monitoring are required after every dose. Blood pressure is checked at 40 minutes — a transient rise of 20-40 mmHg systolic is expected and typically resolves within 90 minutes without intervention. Dissociative symptoms are assessed with the CADSS, and sedation is tracked at intervals. Patients cannot drive after a session; a ride home is a condition of treatment, not a suggestion. Food is restricted for two hours before dosing to reduce nausea, and fluids are restricted for 30 minutes prior.

Depression response is tracked between sessions with the PHQ-9, and suicidality is monitored with the C-SSRS at every visit. For patients treated under the acute suicidal ideation indication, the C-SSRS drives dosing frequency decisions across the first month. The psychiatry team — not a separate infusion clinic — reviews the scores and adjusts the plan.

The induction and maintenance schedule

Induction for treatment-resistant depression runs twice weekly for four weeks — eight sessions total — followed by weekly dosing for four weeks and then every one to two weeks for maintenance based on symptom response. The suicidality indication uses a compressed twice-weekly schedule for four weeks with a separate maintenance decision made at week four. Most patients notice initial mood change within the first week; the durable response consolidates through the full eight-session induction rather than after a single dose.

Response is defined as a 50% reduction in PHQ-9 or a comparable clinician-rated measure; remission is a PHQ-9 under 5. Patients who reach remission during induction typically move to every-other-week maintenance; partial responders may stay weekly for another four to eight weeks before spacing out. Discontinuation is done on a taper — the FDA labeling and clinical experience both support gradual spacing rather than an abrupt stop.

Missed sessions during induction have real consequences for response. The clinic prioritizes scheduling continuity, which is why the Boca Raton drive time — under 25 minutes at rush hour on Federal Highway or I-95 — matters for candidacy in a way it would not for once-monthly medication management.

Spravato with an oral antidepressant, not instead of one

The FDA approval is specifically for esketamine used in conjunction with an oral antidepressant, not as monotherapy. Patients arriving on a partial-response SSRI or SNRI — sertraline, escitalopram, venlafaxine, duloxetine — typically continue that medication throughout Spravato treatment. Stopping the oral agent to “let Spravato work” is not consistent with the label or with the pivotal TRANSFORM and SUSTAIN trial designs.

Patients who have already failed two or more adequate antidepressant trials — the definition of treatment-resistance used for insurance authorization — may start or switch an oral agent at the same time as beginning Spravato. Options include a new SSRI or SNRI, an atypical antidepressant like bupropion or mirtazapine, or augmentation with aripiprazole, quetiapine, or lithium depending on the depressive phenotype. Bipolar spectrum is screened before any mood stabilizer decision.

RECO’s psychiatrists handle the concurrent medication management as part of the Spravato treatment plan — same clinician, same chart. Patients are not asked to keep a separate outside prescriber for the oral regimen, which is how doses drift out of alignment with the esketamine schedule.

Spravato versus IV ketamine — how we choose at the consult

Spravato is FDA-approved for treatment-resistant depression and for MDD with acute suicidal ideation; IV ketamine for depression is off-label. That distinction drives insurance: Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS all cover Spravato under the medical benefit for documented TRD, while IV ketamine is almost exclusively cash-pay. For a patient whose depression has cost them income, insurance coverage often decides the modality by itself.

Dosing differs. Spravato is fixed at 56 mg or 84 mg intranasally; IV ketamine allows weight-based titration (typically 0.5 mg/kg over 40 minutes) and response-based dose escalation across sessions. In-office time is comparable — Spravato requires two hours of post-dose monitoring; IV ketamine typically requires two hours end-to-end for a 40-minute infusion plus recovery. Onset of dissociation is faster with IV; peak dissociative intensity is often lower with intranasal delivery.

The choice at consult is made against insurance status, prior antidepressant and ketamine history, comorbid anxiety or PTSD, and schedule tolerance. RECO’s psychiatrists present both options honestly rather than defaulting to whichever the clinic operates.

What to expect on your first visit from Boca Raton

The first appointment is a 60-minute psychiatric consultation, not a dosing session. The psychiatrist reviews the full antidepressant history — agents tried, doses, durations, response — because Spravato authorization requires documented failure of at least two adequate trials (six weeks at therapeutic dose). A MINI-informed interview screens for bipolar disorder, substance use, and psychotic features, all of which change the treatment plan.

Baseline PHQ-9, GAD-7, and C-SSRS are collected along with vitals and a cardiovascular review — uncontrolled hypertension, recent MI, or aneurysmal vascular disease are relative contraindications given the expected transient blood pressure rise. If Spravato is appropriate, the office initiates prior authorization the same week; most commercial plans return a decision within 5-10 business days.

Insurance and admissions from Boca Raton

RECO Integrated Psychiatry accepts Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Spravato is billed under the medical benefit rather than pharmacy, with the drug and the two-hour observation code submitted per session. Patient responsibility — copay, coinsurance, deductible status — is verified and quoted before the first dose so induction is not started with an unresolved cost question.

Admissions typically move from initial call to first dose within two to three weeks, most of that time spent on prior authorization. The intake team confirms benefits, coordinates the ride-home requirement, and schedules induction sessions in blocks so patients from Boca West or Highland Beach are not driving Federal Highway at random times.

Serving residents of: Mizner Park, Royal Palm Place, Downtown Boca, Boca West, Highland Beach.