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

Wellington sits 28 miles inland from RECO Integrated Psychiatry's Delray Beach office — roughly 38 minutes by car, close enough to sustain the twice-weekly Spravato induction schedule that treatment-resistant depression requires. RECO is a REMS-certified esketamine site staffed by board-certified psychiatrists who handle the concurrent oral antidepressant, the two-hour post-dose monitoring, and the insurance prior authorization under one roof. Clients from Olympia, Versailles, Aero Club, and Palm Beach Polo typically pair the eight-session induction with an established medication plan rather than starting antidepressant therapy from scratch.

Wellington sits 28 miles west of RECO Integrated Psychiatry’s Delray Beach office — a 38-minute drive that becomes a real part of the treatment plan when Spravato induction runs twice weekly for four weeks. Residents of Olympia, Versailles, Aero Club, Palm Beach Polo, and Wellington View who have failed two or more adequate antidepressant trials typically arrive with a specific question: whether esketamine is the correct next step, and whether the REMS monitoring logistics fit their week. This page describes what Spravato treatment actually looks like at RECO, how the eight-session induction is structured, and how the concurrent oral antidepressant fits in.

Spravato and the REMS protocol — what treatment actually looks like

Esketamine is delivered as a nasal spray, self-administered under nursing supervision inside a REMS-certified clinic. The FDA approval covers two indications: treatment-resistant major depressive disorder (TRD) — defined as failure of two or more adequate antidepressant trials in the current episode — and major depressive disorder with acute suicidal ideation or behavior. Standard TRD dosing is 56 mg for the first session and 84 mg thereafter, adjusted for tolerability. The Spravato treatment protocol is precise because the Risk Evaluation and Mitigation Strategy program requires it.

Every session runs approximately two hours after the final device. Blood pressure is checked at 40 minutes because a transient elevation is expected, and pre-existing hypertension is a screening consideration. Dissociative symptoms are quantified using the Clinician-Administered Dissociative States Scale (CADSS); sedation is monitored throughout. Clients cannot drive after the session, and a confirmed ride home is a prerequisite to dosing.

REMS registration, dose logging, and adverse-event documentation are handled by the office. The prescriber, the pharmacy, and the healthcare setting are all federally registered, and the medication is never released to the patient — it is administered on-site and disposed of according to protocol.

The induction and maintenance schedule

TRD induction runs twice weekly for four weeks — eight sessions total — followed by four weekly sessions in weeks five through eight. From there, most patients transition to every-one-or-two-week maintenance based on PHQ-9 trajectory and clinical judgment. The separate suicidality indication follows a twice-weekly cadence for four weeks, with maintenance decisions made after acute stabilization.

Clients typically notice initial change within the first week of dosing, though “response” — defined as a 50% reduction in PHQ-9 — usually consolidates through the eight-session induction rather than after a single dose. RECO documents PHQ-9 and GAD-7 at intake and at set intervals so the response curve is measured, not inferred. The C-SSRS is used at every visit when the suicidality indication is active.

Discontinuation is handled as a taper. Abrupt cessation of maintenance esketamine has been associated with relapse in a similar window as antidepressant discontinuation, so RECO’s psychiatrists decrease frequency in a stepwise manner and reassess before stopping entirely.

Spravato with an oral antidepressant, not instead of one

Esketamine’s FDA approval is specifically for use in conjunction with an oral antidepressant — not as monotherapy. Clients arriving on a partial-response SSRI or SNRI (sertraline, escitalopram, venlafaxine, duloxetine) typically continue that agent through induction, since discontinuing a stabilized medication mid-Spravato introduces a variable that muddies the response assessment.

Clients who have failed multiple oral antidepressants may start or switch an oral agent at the same time as beginning esketamine. Augmentation with aripiprazole, lithium, or quetiapine XR is a standard consideration under APA guidelines, and buspirone remains an option when anxiety symptoms are prominent. RECO’s psychiatry team manages the concurrent regimen directly — the same clinician who orders the Spravato adjusts the oral medication.

For patients with a history of substance use disorder or bipolar spectrum illness, the medication conversation extends further. Mood stabilization typically precedes dissociative-agent trials, and any concern about a hypomanic switch is screened before the first dose using standard mood-disorder history-taking.

Spravato versus IV ketamine and how we choose

Spravato is FDA-approved and covered by most commercial insurance for documented TRD; IV ketamine is off-label and typically cash-pay at $400 to $600 per infusion. Spravato dosing is fixed at 56 mg or 84 mg; IV ketamine allows weight-based (0.5 mg/kg is the most-studied dose) and response-based titration.

Spravato requires two hours of in-office monitoring per session; an IV ketamine visit is typically two hours end-to-end for a 40-minute infusion. The regulatory evidence base is stronger for esketamine — it carries the actual FDA indication — but IV ketamine has decades of anesthetic use and a substantial TRD literature of its own.

The choice usually comes down to insurance, prior response to either agent, and schedule. RECO’s psychiatrists walk through both options at the consult and, where clinically appropriate, refer out for IV ketamine while continuing to manage the oral antidepressant and any ongoing psychotherapy referral (CBT, ACT, or MI-informed work depending on the case).

What to expect on your first visit

The first visit is a psychiatric evaluation, not a dose. A board-certified psychiatrist reviews depression history, prior medication trials (dose, duration, response, and side effects for each), any history of dissociation or psychosis, cardiovascular history and baseline blood pressure, substance use history, and the current oral antidepressant. PHQ-9 and GAD-7 are administered; the C-SSRS screens suicidality; ASRS is added when adult ADHD is on the differential.

If esketamine is clinically indicated and the patient consents, insurance authorization is initiated the same week. First dose is typically scheduled within one to two weeks of the evaluation, coordinated with REMS registration and a confirmed ride home.

Wellington clients who prefer to consolidate intake into a single trip can complete the evaluation and lab review in one visit. Baseline metabolic panels and any medication-specific labs (lithium level, TSH) can be drawn locally and reviewed remotely before the first dose.

Insurance and admissions from Wellington

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and Blue Cross Blue Shield. Spravato coverage generally requires documentation of two or more failed adequate antidepressant trials in the current major depressive episode; RECO’s admissions team gathers that history at intake and submits the prior authorization directly to the payer and specialty pharmacy.

Out-of-pocket costs vary by plan — commercial deductibles, coinsurance, and any specialty pharmacy co-pay for the esketamine itself. Janssen’s CarePath program offers commercial co-pay assistance for eligible patients, and RECO’s team walks through eligibility as part of the authorization workflow.

Most Wellington clients take Southern Boulevard or Route 441 east to I-95 and continue south to the Delray office. The 38-minute drive is a real logistical factor twice a week during induction, and sessions are scheduled in blocks that accommodate the round trip rather than forcing back-to-back appointments.

Serving residents of: Olympia, Versailles, Aero Club, Palm Beach Polo, Wellington View.