Depression treatment for Coral Springs — the full escalation pathway, 35 minutes away.

RECO Integrated Psychiatry sits 35 minutes from Eagle Trace and Heron Bay via the Sawgrass Expressway — close enough for the acute-phase TMS or Spravato appointments that a treatment-resistant depression course actually requires. What Coral Springs referrals get here that they usually don't get locally: a structured differential at intake (MDQ and thyroid screen before the fourth antidepressant), documented adequate trials that will survive a prior-authorization review, and interventional escalation named in writing at trial two rather than trial five. Maintenance follow-ups convert to telepsychiatry once the patient is stable.

Coral Springs sits 25 miles inland from RECO Integrated Psychiatry’s Delray Beach clinic — a 35-minute drive down the Sawgrass Expressway to I-95 for families in Eagle Trace, Hidden Hammocks, Parkland Isles, Cypress Run, and Heron Bay. Depression that a primary care provider has already tried to treat with one or two antidepressants often needs a different level of workup: a structured differential, adequate documented trials that will survive prior authorization, and interventional options named in writing at trial two rather than trial five. That is what the drive buys.

The diagnostic questions primary care doesn’t ask

Before another antidepressant gets written, the diagnosis itself is rechecked. The MDQ and HCL-32 screen for bipolar II and cyclothymic presentations that a fifteen-minute primary care visit routinely misses — and antidepressant monotherapy in unrecognized bipolar illness is the fastest known way to induce a mixed state, precipitate rapid cycling, or trigger a first manic episode. Family history of mania, postpartum psychosis, or documented lithium response in a first-degree relative changes the algorithm before the first prescription is written.

Substance use, subclinical hypothyroidism, chronic sleep restriction, undertreated OCD, and untreated PTSD all present as “depression” in the primary care exam room. RECO’s intake uses the PHQ-9, GAD-7, MDQ, YBOCS, PC-PTSD-5, and ASRS in combination — paired with TSH, free T4, CBC, CMP, B12, folate, and a urine drug screen — so that the treatment plan targets the actual condition rather than layering a fourth antidepressant on top of untreated obsessive-compulsive disorder, cannabis use disorder, or sleep-disordered breathing.

The rule at intake is simple: if the pattern doesn’t fit unipolar major depressive disorder, the diagnosis gets changed on the chart, not on the next visit.

First-line pharmacotherapy done well

For a confirmed DSM-5-TR diagnosis of major depressive disorder, first-line pharmacotherapy is a selective serotonin reuptake inhibitor — sertraline, escitalopram, or fluoxetine — or an SNRI such as venlafaxine XR or duloxetine when pain, prominent somatic anxiety, or a documented prior SSRI failure argues for the class. The starting dose is titrated to a therapeutic dose within two to four weeks, and response is judged on a full six- to eight-week trial with serial PHQ-9 scoring rather than a single subjective report at the follow-up visit.

Bupropion XL is the first-line alternative for patients where SSRI-related sexual dysfunction, weight gain, or blunted affect would predictably drive nonadherence. Mirtazapine is the fit for insomnia-predominant, weight-loss presentations — particularly in older adults. Every prescription documents the dose, the duration, the target PHQ-9 change, and the reason the specific agent was chosen. Adequate dose and adequate duration are the two data points insurance requires before authorizing TMS or Spravato, and the two things scattered treatment histories almost never contain.

Augmentation and switching after partial response

A partial responder — meaningful but incomplete PHQ-9 reduction, typically a 25 to 40 percent drop — is augmented before the antidepressant is switched. First-line augmentation options with the strongest randomized evidence are aripiprazole at 2-15 mg, lithium titrated to a serum level of 0.4-0.8 mEq/L for augmentation (deliberately lower than the mood-stabilization target), and liothyronine (T3) at 25-50 mcg. Quetiapine XR and olanzapine are used where anxiety or agitation dominates, with metabolic monitoring built into the follow-up schedule from the start.

Bupropion augmentation is the tool of choice for residual anergia, hypersomnia, or executive slowing that persists after the SSRI has otherwise worked. Buspirone augmentation is a reasonable option where residual anxiety drives the residual PHQ-9. For true non-responders — under a 25 percent PHQ-9 reduction on an adequate trial — a within-class switch (one SSRI to another) has thin evidence, while a cross-class switch to an SNRI, bupropion, or mirtazapine has better data. The second adequate trial is treated as the decision point for interventional escalation rather than the beginning of an open-ended series of medication swaps.

The interventional escalation pathway

After two adequate antidepressant trials at adequate dose and duration, the patient meets criteria for treatment-resistant depression — the coverage threshold most commercial insurers use to authorize TMS or Spravato. RECO’s depression treatment protocol names the escalation option in writing at trial two rather than allowing the third, fourth, and fifth medication trials to burn through another year of untreated illness while the depression compounds.

Repetitive transcranial magnetic stimulation is delivered to the left dorsolateral prefrontal cortex at 120% of resting motor threshold, approximately 3,000 pulses per session, five sessions per week for six weeks followed by a three-week taper — no anesthesia, no systemic medication, no cognitive side effect profile, and patients drive themselves to and from the appointments. Spravato (esketamine) is offered where a REMS-monitored, rapid-response option fits the clinical picture and the insurance pathway, dosed 56-84 mg intranasally with two hours of monitored observation on site. IV ketamine is available as a cash-pay option for patients who need a compressed schedule or who have failed to secure Spravato coverage. Interventional escalation is planned at intake, not improvised at year two.

What to expect on the first visit

The initial psychiatric evaluation runs 60-90 minutes. The psychiatrist reviews the presenting complaint, the full medication and trial history (with specific dose and duration for each prior antidepressant), family psychiatric history, medical comorbidities, substance use, sleep architecture, and current stressors. Rating scales are completed at intake and repeated at every follow-up — PHQ-9 for depression, GAD-7 for anxiety, MDQ if bipolarity is on the differential, ASRS for adult ADHD when the presentation warrants.

By the end of the visit the patient leaves with a written diagnosis, a specific medication or interventional plan, a defined follow-up interval (typically two to four weeks during titration), and a named escalation option if the current trial doesn’t produce remission. Follow-up visits can be conducted by telepsychiatry for patients whose Coral Springs schedule makes the drive to Delray Beach difficult on a maintenance cadence, provided clinical stability supports remote management.

Insurance and admissions from Coral Springs

RECO is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans commonly held by Coral Springs and Parkland households through employer coverage or the ACA marketplace. TMS and Spravato both require prior authorization; the practice compiles the documentation of prior antidepressant trials, dose, and duration on the patient’s behalf, which is where most external referrals stall for months. New-patient intakes are typically scheduled within one to two weeks, with same-week appointments available for patients in active crisis or stepping down from a higher level of care.

Serving residents of: Eagle Trace, Hidden Hammocks, Parkland Isles, Cypress Run, Heron Bay.