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

RECO Integrated Psychiatry is a REMS-certified Spravato treatment site 35 miles north of Hollywood — about 50 minutes up I-95 outside of rush hour. Board-certified psychiatrists manage both the esketamine sessions and the concurrent oral antidepressant regimen, so Hollywood clients are not split between a dosing center and a separate prescriber. Insurance prior authorization is handled in-house across Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS, and the two-hour post-dose monitoring protocol is delivered by nursing staff at every session.

Hollywood to Delray Beach is 35 miles up I-95 — about 50 minutes outside of rush hour, less once the northbound lanes clear past the Broward–Palm Beach county line. For Hollywood residents pursuing Spravato (esketamine) for treatment-resistant depression, that drive is a manageable twice-weekly commitment during induction and a much lighter one during maintenance. RECO Integrated Psychiatry operates as a REMS-certified Spravato treatment site, delivering esketamine under the FDA-required monitoring protocol alongside concurrent oral antidepressant management.

Spravato and the REMS protocol — what treatment actually looks like

Esketamine is a nasal spray, self-administered in the office under nursing supervision as required by the FDA Risk Evaluation and Mitigation Strategy (REMS). The standard dose for treatment-resistant major depressive disorder is 56 mg for the first session and 84 mg thereafter, adjusted downward for tolerability when a client experiences pronounced dissociation, nausea, or blood pressure elevation. Every session requires a full two hours of post-dose observation before a client can be discharged.

During those two hours, the clinical team tracks three specific things: blood pressure at 40 minutes (a transient systolic and diastolic rise is expected and rarely clinically significant), dissociative symptoms via the Clinician-Administered Dissociative States Scale (CADSS), and sedation level. Clients cannot drive after a session — a ride home is required every time, without exception. RECO handles all REMS pharmacy enrollment, dispensing coordination, and post-session documentation so the client’s only responsibility is showing up and arranging transportation.

The induction and maintenance schedule

For treatment-resistant depression, the induction phase is twice weekly for four weeks — eight total sessions — followed by weekly sessions for the next four weeks, then maintenance dosing every one to two weeks based on symptom response. The alternative indication, major depressive disorder with acute suicidal ideation, runs twice weekly for four weeks with a separate maintenance decision made at that endpoint. Most clients report an initial mood shift within the first week, but the durable response typically consolidates through the full eight-session induction, which is why we do not shorten it.

Response is tracked with the PHQ-9 at every visit and the Columbia Suicide Severity Rating Scale when suicidality is part of the presenting picture. When discontinuation is clinically appropriate — either due to sustained remission or lack of response after adequate exposure — it happens on a slow taper rather than an abrupt stop. Rebound depressive symptoms are more common when Spravato is stopped abruptly, so the maintenance-to-discontinuation transition is treated as its own clinical phase.

Spravato paired with an oral antidepressant, not instead of one

The FDA approval is specifically for esketamine in conjunction with an oral antidepressant — Spravato is not a monotherapy. Clients arriving on a partial-response SSRI like sertraline or an SNRI like venlafaxine typically continue that medication throughout treatment; the esketamine is added on top rather than substituted. This is the most common presentation at intake: a client who has responded partially to their current agent and needs a second mechanism of action to consolidate response.

Clients who meet the strict TRD definition — two adequate trials of different antidepressants at therapeutic dose and duration — may start or switch an oral agent at the same time as beginning Spravato. Adjunctive strategies with aripiprazole, quetiapine, or lithium may enter the picture where there is a mixed-features or treatment-refractory unipolar component. RECO’s psychiatrists manage the oral regimen concurrently, so a client is not shuttling between a Spravato dosing site and a separate prescriber.

Spravato versus IV ketamine — how we decide

Spravato and IV ketamine share a mechanism (NMDA receptor antagonism) but are otherwise distinct treatments. Spravato is FDA-approved for TRD and covered under most commercial plans; IV ketamine is used off-label for depression and is almost always cash-pay. Spravato dosing is fixed at 56 mg or 84 mg; IV ketamine allows weight-based and response-based titration, typically 0.5 mg/kg over 40 minutes for depression protocols.

Time in office is comparable — two hours of post-dose Spravato monitoring, roughly two hours end-to-end for a ketamine infusion once line placement and observation are included. The practical decision usually comes down to three factors: what a client’s insurance will cover, whether there is any prior response history with either compound, and what maintenance cadence fits work and family logistics. Both options are reviewed at the initial consult, and the choice is not made until the psychiatric evaluation is complete.

What to expect on your first visit

The initial appointment is a full psychiatric evaluation, not a Spravato session. A psychiatrist reviews the mood-disorder history in detail — prior antidepressant trials with attention to dose and duration adequacy, response and side-effect profile, comorbid anxiety and substance use, medical history, and a cardiovascular and blood pressure baseline. PHQ-9, GAD-7, and the Columbia Suicide Severity Rating Scale are administered. If a bipolar-spectrum picture emerges, it is worked up before esketamine is initiated.

Once TRD is confirmed and Spravato is the indicated next step, REMS enrollment paperwork is completed at that appointment, insurance prior authorization is submitted the same day (typically 3–7 business days to a decision), and the first dosing session is scheduled. Clients receive written pre-session instructions covering fasting windows, medications to hold, and ride-home arrangements.

Insurance and admissions from Hollywood

Spravato is covered under most commercial plans for documented treatment-resistant depression, including Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Prior authorization requires documentation of the two prior failed antidepressant trials at adequate dose and duration; RECO’s billing team handles the submission and any peer-to-peer reviews that arise.

For Hollywood residents — including clients coming from Hollywood Beach, Emerald Hills, Hollywood Lakes, Hollywood Hills, and Oakwood — the 35-mile drive is the primary logistical question. Most clients time induction sessions to leave Hollywood by 8:30–9:00 AM, complete the session and two-hour monitoring by early afternoon, and head south before the I-95 backup builds. During weekly and then biweekly maintenance, the scheduling burden drops substantially. A ride home is required after every session, so the transportation plan is confirmed at intake and reconfirmed the day before each dose.

Serving residents of: Hollywood Beach, Emerald Hills, Hollywood Lakes, Hollywood Hills, Oakwood.