Residential depression treatment for Miami — TMS and ketamine in-house.

For Miami adults whose depression has failed two or more adequate outpatient antidepressant trials, RECO Immersive's Delray Beach campus is about 65 minutes up I-95 from Brickell — close enough for weekly family involvement, far enough to break contact with local social triggers. In-house rTMS (3000 pulses at 120% motor threshold) and ketamine induction mean interventional escalation happens inside the same treatment plan, with observed oral antidepressant adherence and integration therapy on-site.

From Brickell high-rises, Coral Gables side streets, and the residential blocks around Coconut Grove and Pinecrest, the drive up I-95 to RECO Immersive’s Delray Beach campus runs about 65 minutes in light traffic. For adults whose depression has stopped responding to weekly outpatient therapy and a second or third antidepressant trial, that hour of geographic distance from Miami’s nightlife corridors, family conflict, and work triggers is not incidental — it is part of the clinical rationale for residential rather than day treatment closer to home. Most Miami-based clients combine treatment with on-site sober living rather than attempting a daily commute.

RECO Immersive operates a 24-hour residential depression treatment program for adults with major depressive disorder, persistent depressive disorder, and treatment-resistant depression. In-house TMS and ketamine allow interventional escalation to happen within a single treatment plan rather than through a downstream referral several weeks into an outpatient course.

The clinical presentation this program is built for

Residential depression care at this level of intensity is indicated for adults with severe major depression whose PHQ-9 scores have remained in the 15–27 range despite adequate trials of at least two antidepressants at therapeutic doses for six to eight weeks each. It also fits clients recently discharged from psychiatric hospitalization with residual symptoms — those who cleared safety criteria for step-down but whose functional capacity, sleep architecture, and medication response still need daily observation.

Two other presentations commonly enter residential from South Florida. First, profound anergia and functional collapse — clients who cannot reliably attend a 9 a.m. outpatient IOP group because they cannot get out of bed, shower, or eat without prompting. Second, suicidal ideation without imminent plan or intent, where the clinical need is structure and observed medication trials rather than locked inpatient care. Immersive is not appropriate for clients in acute suicidal crisis, active psychosis requiring involuntary hold, or medically unstable withdrawal — those presentations are triaged to hospital-based care first and admitted to residential only after stabilization.

Concurrent TMS or ketamine during the residential stay

One of the load-bearing advantages of residential over standalone outpatient interventional treatment is that the concurrent oral regimen — sertraline, venlafaxine, bupropion, aripiprazole augmentation, lithium in some presentations — is administered under observation. Sleep is structured, alcohol and cannabis exposure is eliminated, and the integration therapy that follows each ketamine session happens within the hour rather than the client driving back to Brickell alone.

Clients meeting criteria for treatment-resistant depression — typically two or more failed antidepressant trials at adequate dose and duration — frequently begin an rTMS course within the first two weeks of residential. Standard protocol delivers 3000 pulses per session at 120% of motor threshold over the left dorsolateral prefrontal cortex, five days weekly for four to six weeks. Ketamine or intranasal esketamine, when indicated, follows a twice-weekly induction schedule during the residential block. Psychiatry stages this escalation as part of the treatment plan, which shortens the total window from failed outpatient trial to interventional response.

Behavioral activation, CBT for depression, and the daily structure

Depression’s behavioral withdrawal — the collapse of rewarding activity, mastery experience, and social contact — is directly targeted by the residential daily structure. Behavioral Activation is delivered as a formal protocol with activity monitoring, value-linked scheduling, and graded task assignment; it is not translated into generic “get out and do something.” CBT for depression targets cognitive distortions, rumination, and the negative cognitive triad using standardized worksheets and thought records. Interpersonal Therapy is offered for clients whose depression is organized around grief, role transition, or a specific relational conflict.

These modalities are delivered in group four to five times per week and reinforced in twice-weekly individual sessions with the primary therapist. ACT-based defusion and values work is folded in for clients whose rumination has fused with identity or self-concept. DBT skills — distress tolerance and emotion regulation — are drawn on when suicidal ideation or self-harm urges surface during the stay. MI is used to consolidate treatment engagement when ambivalence about medication or interventional treatment appears mid-stay.

What the first 72 hours look like

Admission begins with a nursing assessment, medication reconciliation, and a full psychiatric evaluation within 24 hours of arrival. Baseline scales — PHQ-9, GAD-7, C-SSRS for suicide risk, and the ASRS or YBOCS where the differential warrants — are administered on day one and re-administered weekly. If a co-occurring substance use disorder is present, ASAM Criteria dimensions are documented and a CIWA or COWS protocol is initiated when clinically indicated.

The psychiatry team reviews the outpatient medication history in detail: which SSRIs, SNRIs, and augmenting agents have been trialed, at what doses, for how long, and with what side-effect burden. Decisions about whether to hold, taper, cross-taper, or add an agent are made in the first week rather than deferred. Clients typically meet their primary therapist, psychiatrist, and case manager within the first 48 hours, and family contact is established with written consent on file.

The step-down when depression starts to lift

Residential is a compressed clinical block, not the entire treatment arc. As PHQ-9 trajectory improves and functional capacity returns, the clinical team steps clients down to PHP at RECO Health, which delivers 30 or more clinical hours weekly with home or supported housing at night. PHP is followed by IOP, then by standard weekly outpatient therapy and medication management.

Psychiatry continuity through the step-down matters. The same psychiatrist who initiated the TMS course, ketamine induction, or lithium augmentation continues care through PHP and IOP, so response is measured against the residential baseline rather than reset at each level. The primary therapist typically continues as well, which preserves the therapeutic alliance across the four-to-six-month arc rather than forcing the client to rebuild rapport at each transition.

Insurance and admissions from Miami

Verification of benefits is completed the same day — typically within a few hours — for the carriers Miami-Dade residents most often hold: Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and other BCBS plans. Out-of-network single-case agreements are pursued when medical necessity supports residential rather than PHP. Admissions coordinators arrange transport directly from Miami-Dade home addresses or meet clients at Miami International Airport for those flying in from farther.

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