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

RECO Health runs IV ketamine as a psychiatry-supervised medical treatment, not a standalone infusion service — 0.5 mg/kg over 40 minutes, continuous vitals, CADSS monitoring, and integration therapy the day after each session. For Wellington residents 38 minutes east in Delray Beach, the induction can be paired with PHP or IOP structure and sober-living housing rather than a twice-weekly commute from Palm Beach Polo or Aero Club. Both IV ketamine and Spravato are offered; the choice is made during the psychiatry consult.

Wellington sits roughly 28 miles west of RECO Health’s Delray Beach campus — a 38-minute drive that, in practice, changes how care is delivered. Clients coming from Olympia, Versailles, Aero Club, Palm Beach Polo, or Wellington View rarely commute daily for a six-week induction; more often, IV ketamine is coordinated alongside a short stay in RECO’s sober-living network or paired with PHP and IOP structure, so the medical treatment and the therapy that consolidates it happen inside the same clinical container. This page describes how IV ketamine therapy at RECO is dosed, monitored, and integrated for Wellington residents presenting with treatment-resistant depression, refractory PTSD, or acute suicidal ideation.

Ketamine’s mechanism and why it works fast

Ketamine is a non-competitive NMDA receptor antagonist. At sub-anesthetic doses, blockade of NMDA receptors on GABAergic interneurons produces a downstream surge in glutamate that activates AMPA receptor signaling, which in turn drives brain-derived neurotrophic factor release and rapid synaptogenesis in the medial prefrontal cortex and hippocampus. That cascade — not monoamine reuptake inhibition — is what separates ketamine pharmacologically from the SSRI and SNRI classes.

The clinical consequence is speed. SSRIs like sertraline or escitalopram require four to six weeks to produce measurable change on the PHQ-9. Ketamine’s antidepressant and anti-suicidal effect emerges within hours to days, and in the treatment-resistant depression literature roughly 50-70% of patients meet response criteria after a full induction. That timeline is why ketamine belongs in the TRD pathway after two adequate antidepressant trials have failed, and why it belongs in the crisis pathway when a patient is actively suicidal and six weeks is not clinically available.

Ketamine is not a first-line agent and RECO does not treat it as one. It sits inside a stepped-care framework: full psychiatric evaluation, documentation of prior medication trials, screening for contraindications (uncontrolled hypertension, active psychosis, substance use patterns that would elevate risk), and only then a decision to move to infusion.

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

Each session runs approximately two hours end-to-end. Intake vitals are taken, IV access is established, and 0.5 mg/kg of ketamine is infused over 40 minutes on a programmable pump. Dose is weight-adjusted and, in patients with partial response after the second or third session, titrated upward within the standard therapeutic window. Blood pressure, heart rate, respiratory rate, and oxygen saturation are monitored continuously; dissociative and psychotomimetic symptoms are assessed with the Clinician-Administered Dissociative States Scale (CADSS) during and after the infusion.

Post-infusion recovery lasts 30-60 minutes in a quiet, low-stimulation room until vitals return to baseline and the CADSS score has cleared. Clients cannot drive for the remainder of the day and are discharged to a driver — a logistical detail that matters for Wellington families, since the return drive to Palm Beach Polo or Aero Club needs to be planned in advance.

The induction protocol is six infusions delivered across two to three weeks — typically two per week. That interval is not arbitrary; it is the window in which sustained response either consolidates or fails to consolidate. Response is tracked on the PHQ-9 and, where PTSD is the target, the PCL-5. Non-responders after four to six infusions are moved off the protocol rather than continued indefinitely.

Integration with psychotherapy makes the response durable

Ketamine opens a neuroplastic window. Therapy determines whether the client walks through it. The published literature on ketamine without integration shows shorter response duration and higher relapse rates than protocols that pair infusions with structured psychotherapy, which is why RECO builds integration sessions directly into the induction schedule — typically the day after each infusion, while cognitive flexibility and affective access are still elevated.

Integration work at RECO draws from CBT for depressive rumination, ACT for values clarification and defusion from suicidal thought content, and EMDR or trauma-focused CBT when PTSD is the driver. For clients whose depression is entangled with alcohol or opioid use, motivational interviewing and relapse-prevention work run in parallel, and any comorbid substance use disorder is treated with medication where indicated — buprenorphine or naltrexone for opioid use disorder, naltrexone or acamprosate for alcohol use disorder.

Psychiatric medication is not paused during ketamine. Existing sertraline, aripiprazole, lithium, or quetiapine regimens continue and are adjusted as response emerges. Benzodiazepines are reviewed carefully — chronic high-dose benzodiazepine use blunts ketamine’s antidepressant effect, and where possible, taper is coordinated before or during induction.

IV ketamine versus Spravato — how the decision is made

IV ketamine is off-label for depression. Spravato (esketamine) is FDA-approved for treatment-resistant depression and for depressive symptoms in adults with acute suicidal ideation, is administered intranasally under a REMS protocol, and is covered by most commercial insurance including Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans.

The clinical differences matter. IV ketamine allows precise dose control, faster titration, and a compressed two-to-three-week induction. Spravato is fixed-dose (56 or 84 mg), follows a twice-weekly-for-four-weeks induction, and requires two hours of on-site monitoring per session under REMS. Response profiles overlap but are not identical; some patients who partially respond to Spravato consolidate on IV ketamine, and vice versa.

The decision is made during the psychiatry consult and it is both clinical and financial. Spravato when insurance coverage is the deciding factor and the twice-weekly schedule is workable; IV ketamine when dose flexibility, response quality, or a compressed timeline matter more. RECO offers both.

What to expect on your first visit from Wellington

The first visit is a psychiatric evaluation, not an infusion. A RECO psychiatrist reviews prior antidepressant trials, prior therapy, medical history, and current medications; screens for contraindications; and confirms diagnosis using PHQ-9, GAD-7, PCL-5, and where relevant the C-SSRS for suicide risk. If ketamine is appropriate, a written protocol is issued and the induction is scheduled — usually starting within the same week.

Wellington clients often use the first visit to decide between commuting and pairing the induction with sober-living or PHP-level structure on the Delray Beach campus. For patients with active suicidality or unstable home environments, the second option is generally recommended; for stable outpatients with reliable transportation, twice-weekly commutes from Wellington View or Olympia are workable.

Insurance, cost, and admissions

Spravato is billed to commercial insurance under standard TRD authorization criteria — typically documentation of failure on two prior antidepressants at adequate dose and duration. IV ketamine is generally cash-pay; some plans reimburse the psychiatry component and the integration therapy but not the infusion itself. RECO’s admissions team verifies benefits with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS before the first psychiatric evaluation so the financial picture is clear before any commitment.

Serving residents of: Olympia, Versailles, Aero Club, Palm Beach Polo, Wellington View.