Spravato treatment for Fort Lauderdale — REMS-certified, insurance-covered TRD care.

RECO Integrated Psychiatry is a Spravato REMS-certified outpatient site 40 minutes north of Fort Lauderdale on I-95, delivering nasal esketamine under the full two-hour monitoring protocol the label requires. Fort Lauderdale clients from Las Olas, Victoria Park, and Coral Ridge complete induction — twice weekly for four weeks — without leaving work or family, and the psychiatry team manages the concurrent oral antidepressant rather than referring it out. Prior authorization for Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS is prepared and appealed in-house.

From Las Olas and Victoria Park, RECO Integrated Psychiatry sits 40 minutes north on I-95 — close enough for Fort Lauderdale clients to fit twice-weekly dosing around work and family, far enough that the Delray Beach office provides a genuine change of setting from the routines that tend to reinforce a treatment-resistant depressive episode. The clinic is a REMS-certified esketamine treatment site delivering Spravato treatment for treatment-resistant depression and for major depressive disorder with acute suicidal ideation, in conjunction with an oral antidepressant and under the two-hour post-dose monitoring the FDA label requires.

Spravato and the REMS protocol — what treatment actually looks like

Spravato (esketamine) is delivered as a metered nasal spray. Clients self-administer under direct nursing supervision; the clinician confirms technique, and each device is verified before use. Standard TRD induction dosing is 56 mg for the first session and 84 mg thereafter, titrated for tolerability rather than for symptom chase. The nasal route bypasses first-pass metabolism and reaches peak plasma concentration within 20 to 40 minutes.

The REMS protocol mandates two hours of in-office monitoring after every dose. Blood pressure is measured at 40 minutes — a transient systolic elevation of 20 to 40 mm Hg is expected and rarely clinically actionable; sustained readings above 180/110 trigger a hold and an internal medicine consult. Dissociative symptoms are assessed with the CADSS, sedation is tracked with the MOAA/S, and the treating psychiatrist reviews each session log before discharge. Clients cannot drive for the remainder of the calendar day; a confirmed ride home is a condition of dosing.

Enrollment in the Spravato REMS registry, session-by-session monitoring documentation, and post-dose safety logs are handled by the office. Clients do not touch the REMS paperwork.

The induction and maintenance schedule

For treatment-resistant depression, induction is twice weekly for four weeks — eight sessions in total — followed by weekly dosing for four weeks, then a shift to every one or two weeks in maintenance based on PHQ-9 trajectory and the clinical picture. The MDSI indication (major depressive disorder with acute suicidal ideation) uses twice-weekly dosing for four weeks with a separate maintenance decision at week four; it is not a stand-alone treatment for suicidality apart from concurrent standard-of-care depression management.

An initial mood shift often appears within the first week, but sustained response usually consolidates across the full eight-session induction. Clients who have not shown a meaningful reduction in PHQ-9 or MADRS by session eight are re-evaluated rather than continued reflexively — augmentation, switching the oral antidepressant, or transitioning to rTMS at 3000 pulses per session at 120% of motor threshold are all on the table. Discontinuation, when the time comes, is done on a taper — sessions spaced progressively further apart — rather than an abrupt stop.

Spravato with an oral antidepressant, not instead of one

The FDA label is specifically for esketamine in combination with an oral antidepressant. Clients who arrive on a partial-response SSRI or SNRI — sertraline, escitalopram, venlafaxine, duloxetine — continue that medication through the Spravato course; the oral agent is not decoration, and the pivotal TRANSFORM trials tested the combination, not esketamine monotherapy.

Clients who meet the criterion for TRD — inadequate response to at least two adequate trials of antidepressants at therapeutic dose and duration in the current episode — may start or switch an oral agent concurrent with Spravato initiation. Augmentation strategies including low-dose aripiprazole, quetiapine XR, or lithium are considered where clinically indicated, and buspirone is used where residual anxiety is the limiting symptom. RECO’s psychiatry team manages the concurrent regimen inside the treatment plan rather than referring medication management back to an outside prescriber.

Spravato versus IV ketamine — how the choice is made

Spravato is FDA-approved for TRD and MDSI and is covered by most commercial plans with prior authorization. IV ketamine remains off-label for depression and is almost universally cash-pay in South Florida. Both act at the NMDA receptor, but the two treatments differ in dosing, monitoring, and access.

Spravato dosing 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 adjustment across sessions. Post-dose monitoring is required for both, and total in-office time is comparable. The decision at the consult turns on insurance coverage, prior treatment history, cardiovascular risk, and schedule; the psychiatrist walks through both options rather than defaulting to whatever the office happens to offer.

What to expect on your first visit

The initial appointment is a one-hour diagnostic psychiatric evaluation with the treating psychiatrist — not a triage call or a nurse intake. History covers prior antidepressant trials (drug, dose, duration, documented response), the current episode’s duration and severity, comorbid diagnoses screened with PHQ-9, GAD-7, ASRS, and YBOCS where relevant, and full medical and cardiovascular history. Uncontrolled hypertension, recent MI or stroke, and aneurysmal vascular disease are contraindications; these are ruled out at intake, not at first dose.

If Spravato is clinically indicated and the client meets the TRD or MDSI criterion, prior authorization is initiated the same day. The first dosing session is scheduled once insurance approval and REMS enrollment are complete — typically within one to two weeks. Clients are asked to eat lightly beforehand, avoid caffeine within two hours of the appointment, and arrange a ride home before arrival.

Insurance and admissions from Fort Lauderdale

Spravato is covered under Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and Blue Cross Blue Shield plans for members meeting the TRD or MDSI criterion. Prior authorization is required by every payer; the office prepares the documentation — prior antidepressant trials with dates and doses, current severity scores, prescriber attestation, and the required diagnosis codes — and handles first-line appeals when the initial submission is denied.

For clients driving in from Las Olas, Victoria Park, Coral Ridge, Rio Vista, or Wilton Manors, the 26-mile trip up I-95 to the Delray Beach office runs about 40 minutes outside rush hour. Session appointments are scheduled around the worst commute windows where possible, and Fort Lauderdale clients typically consolidate psychiatry follow-ups with dosing days so a Spravato week does not become two round trips.

Serving residents of: Las Olas, Victoria Park, Coral Ridge, Rio Vista, Wilton Manors.