IV ketamine for Highland Beach — psychiatry-supervised, integrated with therapy.

RECO Health is twelve minutes from Highland Beach up A1A — closer than most Boca specialty practices. IV ketamine here is delivered by a psychiatrist-supervised team with continuous vital-sign monitoring and CADSS-based dissociation tracking, and every infusion is paired with an integration session under CBT, ACT, or EMDR. Ketamine and Spravato are both available under one program, so the modality decision is made clinically, not administratively.

Highland Beach sits on a narrow oceanfront strip between Delray and Boca Raton, roughly twelve minutes up A1A from RECO Health’s Delray Beach campus. For residents of Bel Lido Isle, Toscana, Boca Cove, Ocean Cove, or Penthouse, the clinical density at RECO — board-certified addiction psychiatry, in-house TMS, and IV ketamine integrated with psychotherapy — delivers what general behavioral-health practices in central Boca cannot. IV ketamine here is a psychiatry-supervised medical treatment for treatment-resistant depression, refractory PTSD, and acute suicidality — not a standalone infusion service.

Ketamine’s mechanism and why it works fast

Ketamine is a non-competitive NMDA receptor antagonist. Its antidepressant effect is not driven by the dissociation clients experience during the infusion — it is driven by downstream AMPA receptor throughput, a surge in brain-derived neurotrophic factor (BDNF), and rapid synaptogenesis in the prefrontal circuits that are structurally hypoactive in chronic depression. Standard antidepressants — sertraline, escitalopram, venlafaxine, bupropion — target monoamine reuptake and require four to six weeks before a PHQ-9 score meaningfully moves. Ketamine measurably reduces depressive symptoms and suicidal ideation within twenty-four hours in a subset of responders, and that time-course is the reason it belongs in the treatment-resistant depression pathway and the acute-crisis pathway.

The clinical argument for ketamine is narrow and specific. It is not a first-line antidepressant. It is the agent used when two adequate trials of first-line SSRIs or SNRIs have failed by documented dose and duration, when a patient with active suicidal ideation cannot safely wait six weeks for a medication trial to declare itself, or when PTSD has not responded to prolonged exposure or EMDR paired with an SSRI. RECO’s psychiatry team screens candidates against treatment-resistant depression criteria — including Maudsley staging and prior medication trials with dose, duration, and response — before an infusion series is offered.

The 40-minute infusion and six-session induction

Each infusion session runs approximately two hours end-to-end. Intake includes vital signs, a PHQ-9 or C-SSRS re-screen, and confirmation that the client has transportation home. The infusion itself delivers 0.5 mg/kg of racemic ketamine intravenously over forty minutes, with dose adjustments considered based on weight, prior response, and hemodynamic tolerance. Blood pressure, heart rate, and pulse oximetry are monitored continuously; dissociation is quantified with the Clinician-Administered Dissociative States Scale (CADSS). A registered nurse or advanced-practice provider is in the room throughout.

Recovery lasts thirty to sixty minutes in a low-stimulation setting. Clients are not discharged until vitals normalize and dissociation has cleared, and they cannot drive, operate machinery, or make significant decisions for the remainder of the day. The induction schedule is six infusions across two to three weeks — the interval at which published trials identify sustained response either consolidating or failing to. Response is tracked with serial PHQ-9 or MADRS scores; non-responders after four infusions are re-evaluated and often transitioned to Spravato or a different psychopharmacologic strategy rather than pushed through the remaining sessions on autopilot.

Integration with psychotherapy makes response durable

Ketamine opens a neuroplastic window; the psychotherapy determines whether the client walks through it. RECO’s protocol pairs each infusion with an integration session — typically within twenty-four to forty-eight hours — led by a therapist trained in ACT, CBT, or an EMDR framework appropriate to the client’s presentation. The integration session works with material that surfaced during dissociation, consolidates the cognitive and emotional shifts into behavioral rehearsal, and translates state changes into structure that can survive the closure of the plasticity window.

The published data on this is not subtle. Ketamine delivered without structured psychotherapy produces shorter response duration and higher rates of relapse than ketamine-assisted psychotherapy protocols. That is why RECO does not operate an infusion-only clinic. Clients enrolled in the induction series are concurrently enrolled in weekly psychotherapy — CBT for unipolar depression, prolonged exposure or EMDR for PTSD, DBT skills where affect regulation is the primary target, MI where ambivalence about treatment is the barrier — for the duration of induction and through maintenance.

Ketamine vs Spravato and how we decide

IV racemic ketamine is used off-label; Spravato (esketamine) is FDA-approved for treatment-resistant depression and for depression with acute suicidal ideation, and is covered by most commercial plans — including Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS variants — under the required REMS protocol. Spravato is intranasal, administered in-clinic with a two-hour post-dose observation, and dosed twice weekly for the first four weeks before tapering. IV ketamine offers dose flexibility, a compressed induction, and — in some responders — a qualitatively different response.

The choice is made during the psychiatry consult. When insurance coverage is the deciding factor and the twice-weekly Spravato schedule is workable, Spravato is often the entry point. When a client has already failed Spravato, when finer dose titration is warranted, or when a two-week induction window is clinically appropriate, IV ketamine is used. Both are integrated with the same psychotherapy protocol and the same longitudinal psychiatric follow-up. Ketamine sits inside RECO’s broader ketamine therapy program, which also offers rTMS — typically 3,000 pulses at 120% of motor threshold across a six-week course — for patients who prefer a non-drug alternative.

What to expect on your first visit

The first visit is a psychiatric evaluation, not an infusion. A board-certified psychiatrist reviews medical history, current medications, prior antidepressant trials with documented dose and duration, augmentation history with agents like aripiprazole, lithium, or quetiapine, cardiac history, and any personal or family history of psychosis or mania. PHQ-9, GAD-7, and C-SSRS are administered at baseline; PCL-5 is added where PTSD is suspected, YBOCS where OCD symptoms coexist, and ASRS where a comorbid attention disorder is on the differential. Baseline blood pressure is documented, and any cardiovascular or hepatic red flags are addressed before an infusion is scheduled.

If ketamine is indicated, informed consent is walked through in detail — dissociative effects, transient blood-pressure elevation, nausea, the absolute requirement for a driver, and the empirical response rates. Scheduling of the six-session induction happens at the end of that visit. Highland Beach clients typically fit the series into two or three weekday appointments across two weeks, and the drive from A1A to the Delray Beach campus is twelve minutes each way. Payment structure — whether Spravato via insurance benefits or IV ketamine as cash-pay — is confirmed with admissions before the first infusion is booked.

Serving residents of: Bel Lido Isle, Boca Cove, Ocean Cove, Toscana, Penthouse.