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

RECO Health runs IV ketamine and Spravato as a psychiatry-supervised program integrated with therapy — not as a standalone infusion service. Hollywood clients drive 35 miles up I-95 for the six-session induction, and integration sessions the day after each infusion consolidate response into lasting change. Both racemic IV ketamine and FDA-approved Spravato are available in-house, with the decision made during the psychiatry consult based on treatment history, insurance coverage, and clinical fit.

Hollywood sits 35 miles south of RECO Health’s Delray Beach campus — a 50-minute drive up I-95 outside of rush hour. For clients starting an IV ketamine induction series, that distance is a practical consideration: each infusion day ends with a sober driver home and 24 hours without operating machinery, and clients living in Hollywood Beach, Emerald Hills, Hollywood Lakes, Hollywood Hills, or Oakwood typically arrange dedicated transport on session days or a short stay in Delray during the two- to three-week induction. Ketamine at RECO is a psychiatry-supervised medical treatment integrated with therapy — not a standalone infusion service.

How ketamine works and why the response is fast

Ketamine is a non-competitive NMDA receptor antagonist. The antidepressant mechanism is downstream of that binding: blockade of NMDA on GABAergic interneurons produces a glutamate surge, AMPA receptor activation, brain-derived neurotrophic factor (BDNF) release, and rapid synaptogenesis in the prefrontal cortex. Neuroimaging and preclinical work consistently show restoration of dendritic spine density that chronic stress and depression appear to erode.

Clinically, that translates into a response window SSRIs cannot match. Sertraline, escitalopram, and other first-line agents modulate serotonin reuptake and require four to six weeks before symptom change is measurable on the PHQ-9. Ketamine’s antidepressant and anti-suicidal effect emerges within hours to a few days, with peak response typically observed 24 to 72 hours after the first infusion. In the treatment-resistant depression pathway — defined as failure of two or more adequate trials of a first-line antidepressant — that speed is the reason ketamine has moved from research into clinical practice.

Ketamine is not a first-line antidepressant. It is the agent selected when time is the constraint: acute suicidality, severe treatment-resistant depression, or PTSD refractory to trauma-focused psychotherapy such as EMDR or prolonged exposure. The infusion opens a therapeutic window; the treatment that follows determines whether that window closes on durable change.

The 40-minute infusion, monitored recovery, and the six-session induction

A ketamine session at RECO runs roughly two hours end to end. After baseline vitals and a symptom check, the client is placed in a reclined chair, a peripheral IV is established, and 0.5 mg/kg of ketamine is infused over 40 minutes via pump. The dose is weight-adjusted and occasionally titrated up to 0.75 mg/kg based on prior response and dissociative tolerance. Blood pressure, heart rate, and oxygen saturation are monitored continuously; the Clinician-Administered Dissociative States Scale (CADSS) is used to quantify dissociation during the session.

Recovery lasts 30 to 60 minutes in the same monitored setting. Most clients are alert and oriented within an hour of infusion end, though transient nausea, mild hypertension, and blurred vision are common and expected. Clients cannot drive after an infusion — transport home is arranged in advance, and sessions are not scheduled without a confirmed driver.

The standard induction is six infusions delivered across two to three weeks, typically at two to three sessions per week. That cadence is not arbitrary: the published literature shows response either consolidates within the induction window or does not, and clients who have not moved meaningfully on the PHQ-9 or C-SSRS by session four are re-evaluated rather than pushed through the remaining sessions. For responders, maintenance boosters are scheduled at individualized intervals — often every two to six weeks initially, then extended as response duration lengthens.

Integration with psychotherapy makes response durable

Ketamine opens a neuroplastic window; therapy determines whether the client walks through it. Synaptogenic effects peak in the 24 to 72 hours following infusion — the same window in which integration sessions produce disproportionate cognitive and behavioral traction. RECO’s protocol pairs each infusion with an integration session the following day, using an ACT- or CBT-informed frame, with EMDR or prolonged exposure layered in when PTSD is the primary target and DBT skills work for clients with affective instability or self-harm history.

The published data on ketamine without integration is not encouraging. Response duration is shorter, relapse is faster, and clients frequently return within eight to twelve weeks requesting reinductions rather than boosters. Integration is what separates ketamine as a medical treatment from ketamine as an experience: therapists work with the affective content, imagery, and shifts in self-concept that surfaced during the infusion and consolidate them into behavioral change across the following week.

Concurrent oral medications are reviewed at intake and often adjusted. Lamotrigine can blunt dissociation and is sometimes paused. Benzodiazepines dampen the antidepressant response and are tapered when clinically appropriate. Aripiprazole, quetiapine, lithium, and buspirone as augmentation agents are generally continued through the induction, though timing relative to infusion days is coordinated with the prescribing psychiatrist.

IV ketamine versus Spravato — how the choice is made

RECO offers both racemic IV ketamine and Spravato (esketamine intranasal). The two are pharmacologically related but clinically distinct. Spravato is FDA-approved for treatment-resistant depression and for major depressive disorder with acute suicidal ideation. It is covered by most commercial insurers under a Risk Evaluation and Mitigation Strategy (REMS) protocol requiring in-clinic administration and two hours of monitored observation.

IV ketamine is off-label and, in most cases, cash-pay. The advantages are dose flexibility, faster in-session onset, and a compressed induction — six sessions across two to three weeks rather than eight sessions across four weeks. Response quality is often reported as more coherent by clients who have tried both.

The decision is made during the psychiatry consult and rests on clinical variables — treatment history, dissociative tolerance, concurrent medications — and on financial constraints. Spravato when insurance is decisive and the twice-weekly-for-four-weeks schedule is workable; IV ketamine when dose control, response depth, or a shorter induction matters more.

What to expect at the psychiatry consult

Every ketamine client at RECO starts with a psychiatric intake before any infusion is scheduled. The intake covers diagnostic history, prior medication trials with doses and durations sufficient to establish treatment resistance, current medications, medical history with attention to cardiovascular risk and uncontrolled hypertension, and substance use history. Standardized measures are administered — PHQ-9 for depression severity, GAD-7 for anxiety, C-SSRS for suicidality, PCL-5 when PTSD is the primary target — and repeated across the induction to track objective response.

Absolute contraindications are limited but firm: uncontrolled hypertension, active psychosis, unstable cardiovascular disease, and untreated hyperthyroidism. Relative contraindications — active substance use disorder, prior dissociative complications, high-dose benzodiazepine dependence — are evaluated case by case, sometimes with a stabilization period before the induction begins.

Insurance, admissions, and the drive from Hollywood

The drive from Hollywood to RECO Health is 35 miles up I-95 — 50 minutes outside of rush, closer to 75 during weekday morning traffic. For clients in Hollywood Hills and Oakwood on the west side of the city, Florida’s Turnpike is often the faster route. Spravato sessions are billed through commercial insurance under the REMS protocol; IV ketamine is quoted directly during the consult, generally as a bundled package for the six-session induction.

Admissions coordinators verify benefits before the psychiatry consult and confirm what is covered under the client’s Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, or BCBS plan. For clients whose ketamine treatment is one component of a broader plan — often paired with psychiatry follow-up, TMS at 3000 pulses per session at 120% of motor threshold, or partial hospitalization for co-occurring substance use — the coordinator assembles the full plan of care before treatment begins.

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