Depression — what we treat
- Persistent low mood lasting weeks to months
- Loss of interest in previously enjoyed activities (anhedonia)
- Sleep disturbance (insomnia or hypersomnia)
- Energy loss, fatigue out of proportion to activity
- Difficulty concentrating or making decisions
- Feelings of worthlessness or excessive guilt
- Recurrent thoughts of death or self-harm
How ketamine works for depression
Standard antidepressants work through monoamine systems (serotonin, norepinephrine, dopamine) and take weeks to months to produce mood improvement. Ketamine works on the glutamate system via NMDA receptor modulation, triggering a downstream cascade that increases synaptic plasticity and BDNF expression. The clinically observable effect is rapid — many patients describe meaningful mood improvement within hours to days, compared to the 4-8 week lag with SSRIs. The FDA designated ketamine's nasal-spray cousin (esketamine, Spravato) as a Breakthrough Therapy for treatment-resistant depression in 2019.
The at-home protocol
At-home ketamine therapy for depression typically begins with an induction phase of 6-8 sessions over 4-6 weeks, then transitions to a maintenance schedule based on response. Sublingual rapid-dissolve tablets are used at home with a peer supervisor present. Doses are calibrated to the patient, starting low and adjusting based on tolerability and therapeutic response. PHQ-9 scores are tracked across the course as an objective response marker.
Who's a candidate
Patients with major depressive disorder, persistent depressive disorder, or treatment-resistant depression (defined as inadequate response to ≥2 antidepressant trials at adequate dose and duration) are candidates. Patients with bipolar depression require a stable mood-stabilizer regimen first. Patients with active psychosis, uncontrolled blood pressure, untreated substance use disorder, or pregnancy are not candidates. The eligibility intake screens all of this in detail before any prescription is issued.
Depression in Florida: the local picture
Florida has roughly 21 million residents, with national survey data (SAMHSA NSDUH 2022) suggesting around 8% of adults experience a major depressive episode in a given year. That works out to over a million Floridians annually with active depression — and meaningful proportions (commonly cited around 30%) qualify as treatment-resistant after inadequate response to two or more antidepressant trials. Florida is also designated by the Health Resources & Services Administration (HRSA) as having mental-health professional shortage areas across most counties, which means even patients with insurance often face multi-month waits to see a psychiatrist. Telehealth-delivered at-home ketamine therapy was designed specifically to clear that bottleneck for the patients who can't wait.
Ketamine therapy for Sunny Isles Beach (South Florida) residents
Sunny Isles Beach is a Miami-Dade coastal city with one of the largest Russian-American and Eastern European immigrant communities in Florida, alongside a substantial Latin American international resident population. Cultural barriers to traditional Western-style psychiatric care and language preference create persistent access barriers. At-home telehealth-delivered ketamine therapy offers private care.
Treatment is delivered entirely via telehealth. Sunny Isles Beach-area patients complete an online eligibility intake, have a video consult with Dr. Soffer, and receive prescription medication via mail. Sessions take place in the patient's home with a peer supervisor present. No travel to a clinic, no in-person visits required, anywhere in Miami-Dade County.
Depression + ketamine — common questions
Is at-home ketamine therapy for depression legal in Florida?
Yes. Ketamine is a Schedule III controlled substance that can be legally prescribed by a Florida-licensed physician via telemedicine, and Florida's telehealth statutes explicitly support a video-visit-based physician-patient relationship for controlled substances within the rules of the Ryan Haight Act's telemedicine exception (the patient must have had at least one live video visit with the prescribing physician). The compounded sublingual ketamine is dispensed by a licensed pharmacy and shipped to the patient's home. This is established clinical practice in Florida.
How fast does ketamine therapy work for depression?
Many patients describe meaningful mood improvement within hours to days of the first session, with continued gains over the 6-8 session induction phase. This is fundamentally different from SSRIs, which typically require 4-8 weeks before any benefit appears. The rapid onset is one of the main reasons ketamine is studied for depression that hasn't responded to traditional medications.
Will I have to stop my antidepressant to do ketamine therapy?
No, in most cases. SSRIs, SNRIs, and most other antidepressants are considered compatible with at-home ketamine therapy and continue throughout treatment. Benzodiazepines and certain other medications may require timing adjustments around sessions. Every intake includes a complete medication review before prescribing.
How long does the antidepressant effect of ketamine last?
After the induction series, individual responses vary widely. Some patients maintain benefit with monthly or every-other-month maintenance sessions; others sustain remission for longer periods between sessions. The maintenance schedule is calibrated to each patient based on their response curve and PHQ-9 trajectory.
Depression treatment in nearby FL cities
Important: Compounded ketamine for anxiety, depression, PTSD, and chronic pain is not FDA approved. This page is informational. Eligibility and treatment decisions are made during a physician consultation based on your complete medical history.