Spravato treatment for West Palm Beach — REMS-certified, insurance-covered TRD care.

RECO Integrated Psychiatry is a REMS-certified Spravato site 18 miles south of West Palm Beach — 28 minutes via I-95 or Federal Highway. Induction is delivered on the FDA-labeled TRD schedule with two-hour in-office monitoring, CADSS scoring, and blood pressure checks at 40 minutes, all handled by the same team that manages the concurrent oral antidepressant. Prior authorization is filed with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS before the first dose, so West Palm Beach patients know their out-of-pocket exposure before they commit to induction.

West Palm Beach sits 18 miles north of RECO Integrated Psychiatry’s Delray Beach office, a 28-minute drive down I-95 or Federal Highway outside of rush hour. For adults in El Cid, Flamingo Park, Northwood Hills, SoSo, and Downtown WPB living with treatment-resistant major depressive disorder, the Delray campus is the nearest REMS-certified Spravato treatment site inside Palm Beach County. Insurance coverage is standard for documented TRD, and the induction schedule is defined enough that most West Palm Beach patients can plan the first month of visits around a work calendar.

Spravato and the REMS protocol — what a session actually looks like

RECO Integrated Psychiatry is a Risk Evaluation and Mitigation Strategy (REMS) certified site, which is the FDA-mandated framework for every esketamine administration in the United States. Sessions take place in the office under nursing supervision. The patient self-administers the nasal spray in two to three device applications spaced five minutes apart, then remains in a monitored recovery bay for a full two hours before discharge. Blood pressure is checked at 40 minutes post-dose to catch the transient elevation that is expected with esketamine, dissociative symptoms are scored on the Clinician-Administered Dissociative States Scale (CADSS), and sedation is tracked throughout.

Standard TRD induction dosing is 56 mg for the first session and 84 mg for every subsequent session, adjusted downward for tolerability if blood pressure or dissociative response requires it. Because esketamine produces transient sedation and dissociation, patients are not permitted to drive, operate machinery, or make significant decisions for the remainder of the day — a ride home is required. RECO handles the REMS registration and monitoring documentation on the patient’s behalf; the patient does not need to interface with the federal registry directly.

The induction and maintenance schedule

For treatment-resistant major depressive disorder, induction runs twice weekly for four weeks — eight sessions total. That is followed by a weekly phase for the next four weeks (four sessions), then a maintenance phase dosed every one to two weeks based on symptom trajectory measured against PHQ-9 and structured clinical interview. Most patients notice some initial shift within the first week; sustained response typically consolidates across the eight-session induction, and that is when the medication management team formally reassesses the plan.

The parallel indication — major depressive disorder with acute suicidal ideation or behavior — runs twice weekly for four weeks and then transitions to a separate maintenance decision made with the treating psychiatrist. Discontinuation, when it happens, is a taper rather than an abrupt stop; patients who have responded well and want to space sessions further should expect a stepwise increase in the interval, not a single-session washout.

Spravato is prescribed alongside an oral antidepressant, not instead of one

The FDA approval for esketamine is specifically for use in conjunction with an oral antidepressant — an SSRI, an SNRI, or an atypical such as bupropion or mirtazapine. Patients who arrive on a partial-response agent like sertraline, escitalopram, venlafaxine, or duloxetine typically continue that medication through the Spravato induction; the intent is to hold the oral floor while esketamine drives the acute response. RECO’s psychiatry team owns the concurrent medication management as part of the treatment plan, so patients are not shuttling records between a Spravato site and an outside prescriber.

For patients who have failed multiple prior antidepressant trials, initiation of a new agent or a cross-taper can happen alongside the start of Spravato — commonly a switch to a second-line SNRI, or augmentation with aripiprazole, quetiapine, or lithium if the longitudinal history supports it. Comorbidities are addressed on the same plan: GAD-7 for generalized anxiety, YBOCS for obsessive-compulsive symptoms, and ASRS for adult ADHD screening when the presentation warrants it.

Spravato versus IV ketamine — how we help patients choose

Spravato (esketamine) is FDA-approved for treatment-resistant depression and covered by most commercial insurance for documented TRD. IV ketamine, by contrast, is used off-label for depression and is generally cash-pay at freestanding infusion clinics. That distinction is the single largest driver of the decision for most patients in Palm Beach County, because monthly out-of-pocket exposure differs by an order of magnitude.

Beyond insurance, the two options differ in dosing and monitoring. Spravato dosing is fixed at 56 mg or 84 mg per session; IV ketamine allows weight-based and response-based titration, which some patients find useful after non-response to a fixed regimen. Spravato requires the full two hours of in-office monitoring after nasal administration, while IV ketamine typically runs about two hours end-to-end for a 40-minute infusion. RECO’s psychiatrists walk through prior treatment history, insurance benefits, and scheduling constraints during the initial consult so patients understand what each pathway actually looks like before committing.

What to expect on the first visit from West Palm Beach

The first appointment is a psychiatric evaluation, not a dosing session. The visit covers diagnostic history, prior antidepressant trials with specific dosing and duration (which is what determines whether the case meets the FDA definition of treatment-resistant), medical history relevant to blood pressure and cardiovascular risk, current medications, and any history of psychosis, mania, or substance use. PHQ-9 and the Columbia Suicide Severity Rating Scale anchor the baseline; the Montgomery-Asberg Depression Rating Scale (MADRS) is used at intervals during induction to track response objectively.

If the patient qualifies for Spravato and elects it, REMS enrollment and prior authorization are initiated the same day. West Palm Beach patients should plan for the induction cadence — twice-weekly visits for the first four weeks plus the two-hour post-dose monitoring window — when arranging rides and work coverage. RECO’s front office coordinates recurring appointments in a fixed weekly slot so the drive from El Cid, Flamingo Park, or SoSo becomes predictable rather than a scheduling puzzle each week.

Insurance and admissions from West Palm Beach

RECO Integrated Psychiatry works with most major commercial plans, including Florida Blue, Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare, and Humana. Spravato is billed under the medical or pharmacy benefit depending on the plan; the billing team runs the benefit check and files the prior authorization with the required documentation of two or more failed antidepressant trials at adequate dose and duration. Adequate typically means at least six weeks at a therapeutic dose, per most payer policies.

For West Palm Beach residents, the practical workflow is straightforward: initial psychiatric evaluation, prior authorization filing (usually two to three business days for a decision), REMS enrollment, and the first induction session. From first call to first dose the sequence typically runs one to two weeks depending on payer response and any records that need to be pulled from prior outpatient prescribers.

Serving residents of: El Cid, Flamingo Park, Northwood Hills, SoSo, Downtown WPB.