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

RECO Health delivers IV ketamine 65 minutes north of Brickell at our Delray Beach campus — 0.5 mg/kg infusions over 40 minutes in a monitored clinical setting, paired with next-day integration therapy rather than sold as a standalone infusion service. The full psychiatric team, TMS suite, and inpatient continuum are on the same campus, so Miami clients whose treatment-resistant depression warrants ketamine also have Spravato, rTMS, and medication management available without transferring providers.

From Brickell, Coral Gables, or Aventura, the drive north up I-95 to RECO Health’s Delray Beach campus runs roughly 50 miles and 65 minutes — a distance most Miami clients treat as clinical geography rather than a commute. For residents seeking IV ketamine, that separation from the social triggers of South Beach nightlife or Wynwood after-hours is part of the treatment, and it is why the majority of Miami ketamine clients pair the infusion series with on-campus sober living rather than day-tripping each session.

Ketamine’s mechanism and why response emerges in hours, not weeks

Ketamine is a non-competitive NMDA receptor antagonist. Its rapid antidepressant effect is mediated downstream through AMPA receptor potentiation, BDNF release, and mTOR-driven synaptogenesis in the prefrontal cortex — a fundamentally different mechanism from the monoamine reuptake inhibition of SSRIs like sertraline or SNRIs like venlafaxine.

That mechanistic difference explains the time course. A patient starting sertraline for major depression typically waits four to six weeks for a PHQ-9 response; ketamine’s antidepressant and anti-suicidal effect emerges within hours to days of the first infusion. That speed is the clinical rationale for ketamine’s place in the treatment-resistant depression algorithm and in acute suicidality — not because it displaces first-line SSRIs, but because when the clinical situation cannot afford six weeks, ketamine is the fastest evidence-based intervention available.

Response is not universal. Roughly 50 to 70 percent of TRD patients meet response criteria within the induction series; non-responders are identified early and pivoted to alternative pathways including rTMS at 3000 pulses per session at 120 percent of motor threshold, or intranasal esketamine.

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

Each ketamine session at RECO runs about two hours end to end. Intake vitals and a brief mental status check open the appointment; the infusion itself is 0.5 mg/kg of racemic ketamine delivered over 40 minutes via IV pump, weight-adjusted at intake and occasionally titrated at subsequent sessions based on prior response and CADSS scores. Blood pressure, heart rate, and oxygen saturation are monitored continuously; dissociative symptoms are assessed with the Clinician-Administered Dissociative States Scale before, during, and after the infusion.

Recovery is 30 to 60 minutes of monitored downtime in a low-stimulus room. Clients are required to have a driver — for Miami clients staying on campus in sober living, this is the on-site transport team; for those commuting, family or a rideshare. Driving is prohibited for the remainder of the day, and clients are advised against major decisions or contract-signing for 24 hours.

The induction series is six infusions across two to three weeks — typically Monday, Wednesday, and Friday for two consecutive weeks. That interval is where sustained response either consolidates or does not, and the psychiatrist’s decision at session six is one of three: proceed to maintenance boosters at three to six week intervals, pivot to Spravato, or discontinue ketamine in favor of another pathway.

Integration therapy is what makes response durable

Ketamine opens a neuroplasticity window. Therapy determines whether the client walks through it. RECO’s IV ketamine therapy program pairs the infusion series with structured integration sessions the day after each infusion, where a therapist trained in ketamine-assisted psychotherapy works with the material that surfaced during dissociation — often trauma content, self-narrative shifts, or cognitive reframes that would take months to reach in standard CBT.

Integration draws from ACT, Internal Family Systems, and trauma-focused modalities including EMDR for clients with a PTSD component. For clients whose ketamine indication is treatment-resistant depression rather than trauma, the integration work is closer to behavioral activation and cognitive restructuring — leveraging the temporary lift in affect to install habits and reframes that will persist after the pharmacological effect fades.

The published outcome data is consistent on this point: ketamine without integration produces shorter response duration and higher relapse rates. Infusion-only protocols are not offered at RECO.

IV ketamine versus Spravato — how the decision gets made

IV ketamine is racemic — both R- and S-enantiomers — delivered off-label and cash-pay in nearly all cases. Spravato (esketamine) is the S-enantiomer only, delivered intranasally, FDA-approved for treatment-resistant depression and for depression with acute suicidal ideation, and covered by most commercial insurance including Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS under a REMS-certified protocol.

The choice is clinical and financial. Spravato is the answer when insurance coverage is the deciding factor, when a twice-weekly-for-four-weeks induction schedule is workable, and when the client tolerates intranasal administration. IV ketamine is the answer when dose flexibility matters, when prior Spravato has produced only partial response, when a compressed two-week induction is clinically urgent, or when the psychiatrist judges IV bioavailability and titration control worth the out-of-pocket cost.

That decision is not made from a website. It is made in the initial psychiatry consult after review of medication history, prior TRD interventions — typically failure of at least two adequate SSRI or SNRI trials, often with augmentation by aripiprazole, quetiapine, or lithium — and current PHQ-9 and C-SSRS scores.

What to expect at your first appointment from Miami

The first appointment is not an infusion. It is a 60 to 90 minute psychiatric evaluation with a board-certified psychiatrist covering full medication history, prior response to SSRIs and SNRIs, any exposure to atypicals such as aripiprazole or olanzapine augmentation, prior rTMS or ECT, substance use history, and a formal C-SSRS suicide risk assessment.

For Miami clients driving up from Brickell or Coral Gables, this consult is scheduled to allow a same-day tour of the Delray Beach campus and, where indicated, a housing intake for on-site sober living during the induction. Clients with an active substance use component — not uncommon in TRD referrals from Miami’s nightlife-adjacent professional population — are assessed against ASAM Criteria dimensions and may be routed through medical detox with CIWA or COWS monitoring, and stabilization on buprenorphine or naltrexone where indicated, before ketamine is initiated.

Insurance, admissions, and getting here from Miami

IV ketamine at RECO is typically cash-pay; Spravato is billed to insurance under REMS. RECO Health is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans for the wraparound psychiatry, therapy, PHP, and IOP that accompany ketamine treatment — meaning the infusion itself may be out-of-pocket while the surrounding continuum of care is covered.

The Delray Beach campus is 50 miles up I-95 from Brickell, roughly 65 minutes in typical midday traffic; from Aventura or Pinecrest, subtract 10 to 15 minutes; from Coconut Grove, add the same. Admissions handles insurance verification, benefits estimation, and — for clients staying on-campus during induction — housing intake in a single call.

Serving residents of: Brickell, Coral Gables, Coconut Grove, Aventura, Pinecrest.