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

For West Palm Beach residents, RECO Health's Delray Beach campus is the nearest psychiatry-supervised IV ketamine program — 18 miles south down I-95, roughly 28 minutes outside rush. Ketamine here is delivered by a psychiatric team, monitored with continuous vitals and CADSS scoring, and paired with next-day integration therapy rather than run as a standalone infusion. That integrated model — psychiatry, infusion, integration therapy, and access to rTMS and esketamine when clinically indicated — is why the response tends to hold beyond the six-session induction window.

West Palm Beach sits 18 miles north of RECO Health’s Delray Beach campus — a 28-minute drive down I-95 or Federal Highway outside rush hour. For Palm Beach County residents living in El Cid, Flamingo Park, Northwood Hills, SoSo, or downtown WPB, that’s the nearest psychiatry-supervised IV ketamine program integrated with a full continuum of mental health care. Ketamine at RECO is a medical treatment for treatment-resistant depression, acute suicidality, and refractory PTSD — not a boutique infusion service delivered in isolation.

Why ketamine works when SSRIs haven’t

Ketamine is a non-competitive NMDA receptor antagonist. Blocking NMDA on inhibitory interneurons produces a downstream surge of glutamate, which activates AMPA receptors and drives BDNF-mediated synaptogenesis in the prefrontal cortex within hours of infusion. That cascade sits entirely outside the monoamine reuptake system that sertraline, escitalopram, venlafaxine, and every other first-line antidepressant targets. It is the mechanistic reason a client who has failed three adequate SSRI or SNRI trials can still respond to ketamine.

The clinical consequence is speed. SSRIs require four to six weeks to produce meaningful movement on the PHQ-9. Ketamine’s antidepressant effect emerges within hours to days, and the anti-suicidal effect — measured on the C-SSRS or the SSI — often within a single session. That speed is why ketamine belongs in the treatment-resistant depression pathway alongside rTMS and esketamine, and why it belongs in the acute crisis pathway when six weeks is not a schedule the client’s clinical picture allows.

The decision to move to ketamine at RECO is made after a psychiatric evaluation confirms the diagnosis — unipolar TRD, bipolar depression with adequate mood stabilization on lithium or quetiapine, refractory PTSD, or severe suicidality — reviews adequacy of prior trials, and screens for the short list of contraindications: uncontrolled hypertension, unstable cardiac disease, active psychosis, and active substance use disorder without concurrent treatment.

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

Each session runs roughly two hours end-to-end. Intake vitals and a brief symptom check (PHQ-9, GAD-7, C-SSRS) establish the day’s baseline. The infusion itself is 0.5 mg/kg of racemic ketamine over 40 minutes, delivered by pump, weight-adjusted and occasionally titrated upward in later sessions based on prior response and tolerability. Blood pressure, heart rate, and oxygen saturation are recorded continuously; dissociative symptoms are tracked with the CADSS. A psychiatric nurse and the supervising psychiatrist are on site for every infusion.

Recovery runs 30 to 60 minutes in a quiet room with continued vital-sign monitoring until the client is oriented, ambulatory, and hemodynamically stable. Nausea, transient blood pressure elevation, and dissociative aftershocks are the common short-term effects — managed on site with ondansetron, close monitoring, or simple time. Clients cannot drive themselves home; the ride is arranged in advance.

The induction protocol is six infusions across two to three weeks. That interval is where sustained response either consolidates or doesn’t. A client showing meaningful PHQ-9 reduction by session three or four is a likely responder; a client with no movement by session six is unlikely to respond to further infusions, and the psychiatry team pivots — to esketamine, to rTMS at 3000 pulses per session at 120% of motor threshold, or to an augmentation strategy with lithium, aripiprazole, or quetiapine. Maintenance boosters, when indicated, are scheduled every two to six weeks based on observed duration of response.

Integration therapy is what makes ketamine last

Ketamine opens a window. Therapy determines whether the client walks through it. RECO’s protocol pairs the infusion series with integration sessions — typically the morning after each infusion — where the therapist works with the material that surfaced during the session (memories, affect states, dissociative content, cognitive reframes) and consolidates the shift into durable change.

The evidence base here is directional and consistent. Ketamine delivered without any structured psychotherapy shows shorter response duration and higher relapse rates than ketamine paired with CBT, ACT, or ketamine-assisted psychotherapy. At RECO the integration therapist is trained in the specific work — using motivational interviewing to solidify the client’s own reasons for change, using CBT to test new cognitions against real-world experience, and using EMDR or trauma-focused work in clients whose depression sits on top of unprocessed trauma.

That integrated model is why our ketamine therapy is delivered inside a psychiatry-and-therapy program rather than as a standalone infusion service. Standalone infusion clinics can produce the acute response; they cannot reliably produce the durable one.

IV ketamine versus Spravato, and how we decide

IV racemic ketamine is off-label and cash-pay in most cases. Spravato (esketamine) is FDA-approved for treatment-resistant depression and for major depressive disorder with acute suicidality, and is covered by Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS under the manufacturer’s REMS protocol. Both drugs work through the same NMDA-AMPA-BDNF axis; the clinical differences are dose flexibility, response quality, and schedule.

The decision is made during the psychiatry consult. Spravato is the right answer when insurance coverage is the deciding financial constraint and the twice-weekly-for-four-weeks induction schedule is workable. IV ketamine is the right answer when dose flexibility matters — the psychiatrist can titrate, Spravato is fixed at 56 or 84 mg — when a compressed two-to-three-week induction matters, or when the client failed to respond to Spravato and a mechanistically similar but pharmacokinetically distinct trial is clinically warranted. RECO offers both, and clients who begin on one and cross over to the other are common.

What to expect on your first visit

The intake is a 90-minute psychiatric evaluation with the ketamine-program psychiatrist, not an infusion. Diagnosis, medication history, treatment history, medical history, current medications (including buspirone, buprenorphine, naltrexone, or any mood stabilizer that changes the risk picture), and a screen for medical and psychiatric contraindications are covered. The C-SSRS, PHQ-9, and GAD-7 are administered. Prior trial adequacy is documented — a client who “failed sertraline” but took 25 mg for two weeks has not had an adequate trial, and the treatment plan reflects that.

A treatment plan is written the same day. If IV ketamine is indicated, the first infusion is typically scheduled within one to two weeks, subject to lab work — basic metabolic panel, urine drug screen, pregnancy test where applicable, and an EKG in clients over 55 or with cardiac history. The integration therapist is assigned at the same visit and meets the client before the first infusion.

Insurance and admissions from West Palm Beach

Spravato is billed through medical insurance and is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. IV ketamine is cash-pay; the admissions team quotes full induction cost and available financing on the first call. For West Palm Beach residents the drive is 18 miles — 28 minutes down I-95 or Federal Highway outside rush, closer to 40 during afternoon peak. That’s the practical constraint for a program that requires six visits across two to three weeks: it has to be reachable on a weekday, and from El Cid, Flamingo Park, or downtown WPB it is.

Serving residents of: El Cid, Flamingo Park, Northwood Hills, SoSo, Downtown WPB.