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

RECO Integrated Psychiatry is a REMS-certified Spravato site 65 minutes north of Miami in Delray Beach. Miami clients from Brickell, Coral Gables, and Aventura come for the same-provider model: the psychiatrist prescribing your oral antidepressant is also the one supervising each esketamine session, so the eight-session induction and any maintenance decisions stay coordinated across one treatment plan. Prior authorization for Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS is handled in-house, and on-site sober-living housing is available for clients who prefer to consolidate the twice-weekly induction phase rather than commute.

From Brickell, Coral Gables, or Aventura, the drive up I-95 to RECO Integrated Psychiatry’s Delray Beach office runs about 65 minutes — long enough that Miami clients typically build Spravato treatment around a fixed weekly schedule rather than treating it as an errand. Esketamine’s REMS requirements — two hours of in-office monitoring and no driving afterward — also mean each session is a half-day commitment, which shapes how we design the treatment calendar for clients commuting from Dade County. For many, the geographic distance from the Miami social scene is itself part of the clinical value.

Spravato and the REMS protocol — what treatment actually looks like

Spravato is esketamine, the S-enantiomer of ketamine, delivered as a nasal spray under the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program. At RECO Integrated Psychiatry, clients self-administer the spray in-office under nursing supervision. Standard dosing is 56 mg for the first session and 84 mg from session two onward, adjusted downward for tolerability if dissociation, sedation, or sustained blood pressure elevation warrant it.

Every session includes two hours of post-dose monitoring. Blood pressure is checked at 40 minutes because transient systolic elevation of 20-40 mmHg is expected and time-limited. Dissociative symptoms are quantified with the CADSS (Clinician-Administered Dissociative States Scale), and sedation is tracked with the Modified Observer’s Assessment of Alertness/Sedation. Clients cannot drive for the remainder of the day, so a ride home is mandatory — most Miami clients coordinate with a family member, rideshare, or an affiliated sober-companion service.

REMS registration, pharmacy coordination, and monitoring documentation are handled entirely by the office. Clients do not source the medication themselves; it is dispensed and administered on-site at each visit.

The induction and maintenance schedule

For treatment-resistant major depressive disorder, induction is twice weekly for four weeks — eight sessions — followed by weekly dosing for four weeks (four sessions), then a taper to every one or two weeks for maintenance based on response measured on the PHQ-9 and MADRS. Response is formally reassessed at week four and again at week eight before any maintenance decision is made.

For major depressive disorder with acute suicidal ideation or behavior, induction runs twice weekly for four weeks alongside standard-of-care treatment, and the maintenance decision is made separately at the four-week mark based on residual suicidality (C-SSRS) and depression severity. This indication is often used as a bridge while an oral antidepressant regimen is titrated to therapeutic effect.

Most clients report an initial mood shift within the first week; sustained response consolidates through the eight-session induction. Discontinuation, when clinically appropriate, is done on a taper rather than abruptly to reduce the risk of rebound depressive symptoms.

Spravato with an oral antidepressant, not instead of one

The FDA label for esketamine is specific: it is approved in conjunction with an oral antidepressant, not as monotherapy. Clients who arrive on a partial-response SSRI (sertraline, escitalopram) or SNRI (venlafaxine, duloxetine) typically continue that medication through the Spravato induction — the goal is augmentation, not replacement.

Clients who have failed multiple oral agents may start or switch an antidepressant at the same time as beginning Spravato treatment. Common concurrent choices include venlafaxine XR titrated toward 225 mg, aripiprazole augmentation at 2-5 mg, or lithium augmentation for clients with a bipolar-spectrum presentation. RECO’s psychiatry team manages both the Spravato protocol and the oral medication regimen as a single treatment plan rather than splitting care between two providers.

For clients with comorbid anxiety, insomnia, or substance use, the medication plan may also include buspirone, low-dose quetiapine, or naltrexone. Concurrent psychotherapy — CBT for depression, ACT for values-based behavioral activation, or EMDR for underlying trauma — is coordinated through in-network referrals or telehealth.

Spravato versus IV ketamine, and how we choose

Spravato and IV ketamine are related compounds with different regulatory and clinical profiles. Spravato is FDA-approved for TRD and for MDD with suicidality, is covered by most commercial insurance, and is dosed at fixed strengths of 56 mg or 84 mg. IV ketamine is off-label for depression, is typically cash-pay at $400-600 per infusion, and allows weight-based (0.5 mg/kg is the research-standard starting dose) and response-based titration.

Session logistics are similar. Spravato runs roughly 2.5 hours door-to-door once the two-hour monitoring window is included. A standard 40-minute IV ketamine infusion also runs about two hours end-to-end after vitals and recovery. Both require a driver home and abstention from driving that day.

The choice depends on insurance status, prior treatment response, and clinical presentation. Clients with documented TRD and commercial coverage generally start with Spravato because it is covered and the evidence base for the labeled indication is stronger. Clients who have already trialed Spravato without adequate response, or who need weight-based titration for a complex presentation, may be better candidates for IV ketamine. RECO’s psychiatrists walk through both at the consultation.

What to expect on your first visit

The intake is a 60-minute psychiatric evaluation, not a dosing session. The psychiatrist reviews depression history, every prior antidepressant trial with dose, duration, and reason for discontinuation, suicidality history using the C-SSRS, substance use screening, and medical comorbidities relevant to REMS eligibility. Uncontrolled hypertension, aneurysmal vascular disease, and pregnancy are the primary exclusions. PHQ-9, GAD-7, and often ASRS are administered as baseline measures.

If Spravato is indicated, REMS enrollment and insurance prior authorization begin the same day. The first dosing session is typically scheduled within one to two weeks. Session one uses the 56 mg dose; sessions two through eight step up to 84 mg unless tolerability requires dose reduction. Clients are asked to eat lightly beforehand, avoid benzodiazepines the morning of dosing (they blunt the antidepressant effect), and arrange a ride home.

Insurance and admissions from Miami

Spravato is covered under most commercial plans for documented TRD. Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS are all commonly billed at RECO Integrated Psychiatry. Prior authorization requires documentation of at least two failed adequate trials of oral antidepressants — each at therapeutic dose for at least six weeks — and the office handles the authorization submission. Session copays typically fall in the $20-75 range after deductible.

Miami clients coming from Brickell, Coral Gables, Coconut Grove, Aventura, or Pinecrest typically build treatment around a two-visit-per-week induction schedule. The drive is roughly 50 miles on I-95 or the Florida Turnpike, running about 65 minutes outside rush hour and closer to 90 during peaks. For clients who prefer to consolidate the induction phase, on-site sober-living housing through RECO’s affiliated recovery residences is available — practical for the twice-weekly dosing schedule and useful when the Miami social environment has been part of what has kept a depressive episode from remitting.

Serving residents of: Brickell, Coral Gables, Coconut Grove, Aventura, Pinecrest.