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

RECO Health's IV ketamine program is 32 miles south of Jupiter on I-95 — 45 minutes outside of rush hour, workable for Abacoa and Tequesta families running a six-infusion induction across two to three weeks without relocating. Ketamine here is psychiatry-supervised and paired with integration therapy the day after each session; it is not a standalone infusion service. Both IV racemic ketamine and Spravato are offered, and the choice is made during the psychiatry consult based on treatment history, insurance, and clinical presentation.

Jupiter sits 32 miles north of RECO Health’s Delray Beach campus — a 45-minute run down I-95 outside of rush hour. For clients in Abacoa, Tequesta, Jupiter Inlet Colony, Admirals Cove, or Jonathan’s Landing weighing IV ketamine for treatment-resistant depression, the geography works: close enough for a six-infusion induction across two to three weeks without relocating, far enough that the Delray campus offers genuine separation from the environments that drove the depression.

Why ketamine works when SSRIs don’t — the mechanism

Ketamine is a non-competitive NMDA receptor antagonist. That single pharmacological fact reframes the treatment: it does not target monoamine reuptake the way sertraline, escitalopram, or venlafaxine do, which is why it does not need weeks of receptor adaptation to produce a clinical response. Blockade of NMDA receptors on GABAergic interneurons produces a downstream disinhibition of glutamate release, activation of AMPA receptors, BDNF release, and rapid synaptogenesis in the prefrontal cortex. In treatment-resistant depression — defined as inadequate response to at least two adequately dosed antidepressant trials — the clinically relevant effect emerges within hours to days, not weeks.

That speed is why ketamine occupies two specific niches in the psychiatry pathway. The first is treatment-resistant depression in a client who has already cycled through SSRI, SNRI, augmentation with aripiprazole or quetiapine, and often lithium — and cannot afford another six-week trial. The second is acute suicidality, where the timeline between symptom and safety is measured in hours. Ketamine is not a first-line antidepressant. It is what psychiatry uses when the timeline available to the client no longer accommodates the timeline SSRIs require.

The 40-minute infusion, the CADSS, and the six-session induction

Each session runs roughly two hours from door to door. Intake vitals — blood pressure, heart rate, oxygen saturation — are recorded before the IV is placed. The infusion itself is 0.5 mg/kg of racemic ketamine, weight-adjusted, delivered over 40 minutes via infusion pump; the dose is occasionally titrated up in subsequent sessions based on tolerability and response. During the infusion, vitals are monitored continuously and dissociative symptoms are assessed with the Clinician-Administered Dissociative States Scale (CADSS). Nursing staff remain in the room.

After the infusion, clients recover for 30 to 60 minutes in a monitored setting until dissociation resolves and vitals return to baseline. Nausea, transient hypertension of 15 to 20 mmHg, and mild disorientation are the common side effects; each is anticipated and managed. Because operating a vehicle is contraindicated for the rest of the day, clients are driven home — a logistical detail worth planning around for Jupiter families where a partner or parent is doing the round trip.

The induction series is six infusions across two to three weeks — typically a Monday-Wednesday-Friday cadence or twice weekly. That interval is where sustained response either consolidates or does not; a client who has not responded meaningfully by infusion four is unlikely to respond further, and the psychiatrist will pivot rather than complete the series. Maintenance infusions, when indicated, are scheduled every two to six weeks based on the duration of response each client achieves.

Integration with psychotherapy makes the response durable

The published literature is consistent: ketamine without psychotherapeutic integration produces shorter response duration and higher relapse rates than ketamine paired with structured therapy. The infusion opens a window of neuroplasticity; whether the cognitive and emotional shifts that occur during and after the session consolidate into lasting behavior change depends on what happens outside the infusion room.

RECO’s protocol pairs the six-infusion induction with integration therapy sessions, typically scheduled the day after each infusion while the neuroplastic window is still open. The therapist works with material that surfaced during the dissociative state — often material the client had been unable to access in traditional weekly therapy — and integrates it using ACT, CBT, or EMDR depending on the clinical picture. For PTSD refractory to first-line care, EMDR pairs particularly well with the ketamine window. For depression anchored in behavioral withdrawal, ACT-based values work and behavioral activation are the higher-yield integration modalities.

IV ketamine or Spravato — how the decision gets made

Two ketamine products are used clinically for depression, and they are not interchangeable. IV racemic ketamine is off-label, cash-pay in most cases, and offers full dose flexibility. Spravato (intranasal esketamine) is FDA-approved for treatment-resistant depression and for depression with acute suicidal ideation, is covered by most commercial insurance under a REMS protocol, and follows a fixed schedule — twice-weekly induction for four weeks, then weekly, then every one to two weeks — with observation for two hours after every dose.

The decision is clinical and financial. Spravato is the right choice when insurance coverage is the deciding factor, when the fixed schedule works with the client’s life, or when the client prefers intranasal administration. IV ketamine is the right choice when dose flexibility matters, when a compressed induction schedule is preferred, when the client has failed Spravato, or when response quality with IV administration has been demonstrably better in prior treatment. RECO offers both, and the choice is made during the psychiatry consult — not before it — because the answer depends on treatment history, insurance, and clinical presentation.

What the first visit from Jupiter looks like

The first appointment is a psychiatric consultation, not an infusion. A board-certified psychiatrist reviews the treatment history in detail — every antidepressant tried, dose, duration, response, and reason for discontinuation — along with medical history, current medications, and cardiovascular status. Poorly controlled hypertension is a relative contraindication and requires medical clearance. Clients complete the PHQ-9 and the GAD-7; those scores anchor treatment response tracking across the induction, and clients with prominent anxiety or OCD features also complete the YBOCS at intake.

If the client is a candidate, informed consent is reviewed in writing — including the dissociative experience, transient blood pressure elevation, the driving restriction, and the off-label status of IV ketamine for depression. Concurrent medications are reviewed for interactions; benzodiazepines and lamotrigine can blunt the antidepressant response and are sometimes tapered before induction. The first infusion is typically scheduled within one to two weeks of the consult.

Insurance and admissions from Jupiter

Spravato is billed to Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS under the medication and administration codes appropriate to the REMS protocol; verification is done before the first dose. IV ketamine is generally cash-pay, with per-infusion pricing quoted at the psychiatry consult and package pricing available for the six-infusion induction. Some plans reimburse a portion under out-of-network mental health benefits when superbilled.

The drive from Jupiter to Delray Beach is 32 miles down I-95, typically 45 to 55 minutes outside of rush hour and up to 75 during season. On infusion days a driver is required. Admissions can schedule the consult, insurance verification, and the induction series in one call — more detail on the full IV ketamine therapy program is available on the service page.

Serving residents of: Abacoa, Jupiter Inlet Colony, Tequesta, Admirals Cove, Jonathan's Landing.