Depression treatment for Delray Beach — the full escalation pathway, 0 minutes away.

RECO Integrated Psychiatry's office sits inside Delray Beach itself — under fifteen minutes from Pineapple Grove, Lake Ida, Tropic Isle, Osceola Park, and the Beach District. Depression treatment here is structured around DSM-5-TR criteria and PHQ-9 tracking, with SSRI or SNRI trials documented for dose and duration, evidence-based augmentation with aripiprazole, lithium, or T3, and TMS or Spravato named at trial two rather than trial five. Same-week intake is standard, and Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS are all in-network.

The four-block stretch of Atlantic Avenue between Swinton and the Intracoastal — the coffee shops, the tennis center, the Saturday market at Old School Square — is the everyday footprint of most adults living in Delray Beach. Effective psychiatric care for someone who lives here should not require leaving that footprint. Depression treatment at RECO Integrated Psychiatry is delivered from an office in the same neighborhood — minutes from Pineapple Grove, Lake Ida, Tropic Isle, Osceola Park, and the Beach District — and is structured around a documented DSM-5-TR diagnosis, a baseline PHQ-9, and a written medication algorithm rather than open-ended supportive visits.

The diagnostic questions primary care doesn’t ask

Before a clinician treats a presentation as major depressive disorder, several other diagnoses have to be ruled out — because antidepressant monotherapy in the wrong condition frequently makes symptoms worse. The most consequential miss is bipolar spectrum illness. Bipolar II depression looks identical to unipolar depression on the surface, and starting an SSRI or SNRI without screening for hypomania can induce mixed states, rapid cycling, and destabilization that takes months to reverse. The initial evaluation at RECO Integrated Psychiatry includes the MDQ and HCL-32, a structured mood history covering periods of decreased need for sleep and goal-directed acceleration, and a family history of bipolar disorder or completed suicide.

Substance use, subclinical hypothyroidism, chronic sleep deprivation, untreated ADHD (screened with the ASRS), undertreated OCD (YBOCS), and PTSD all present as “depression” in primary care and require the underlying condition to be treated instead of a fourth antidepressant layered on top. TSH, free T4, CBC, CMP, vitamin B12, vitamin D, and hemoglobin A1c are drawn at intake or reviewed if recent. When these misdiagnoses get caught at intake rather than at trial four, the treatment plan actually converges.

First-line pharmacotherapy done well

First-line pharmacotherapy for major depressive disorder is an SSRI (sertraline, escitalopram, or fluoxetine) or an SNRI (venlafaxine XR or duloxetine), started at a starting dose, titrated to a therapeutic dose within two to four weeks, and given a full six to eight weeks at therapeutic dose before response is judged. Bupropion is first-line for clients where sexual side effects, sedation, weight gain, or blunted affect on serotonergic medications are dealbreakers. Mirtazapine is used when insomnia and low appetite dominate the presentation and a nighttime, appetite-restoring agent is a better fit.

The two things that matter more than the specific molecule chosen are dose and duration. An SSRI titrated to therapeutic dose and given eight weeks is a completed trial; the same medication left at a starting dose for three months is not. Insurance carriers require documented adequate trials — specific dose and specific duration — before authorizing TMS or Spravato later, and scattered treatment histories from prior prescribers usually do not have them. Every trial at RECO is documented with dose, date, and PHQ-9 at start and end.

Augmentation and switching after partial response

Partial responders — clients with a meaningful but incomplete PHQ-9 reduction after an adequate trial — are augmented before the antidepressant is switched, because the response already gained is real and worth preserving. The augmentation options with the strongest evidence in the STAR*D and CO-MED data are aripiprazole at 2 to 15 mg, lithium targeted to an augmentation level of 0.4 to 0.8 mEq/L, and T3 at 25 to 50 mcg. Bupropion is added when residual anergia, low motivation, or executive slowing are the dominant remaining symptoms. Quetiapine XR is an option when comorbid insomnia and anxiety persist alongside the depressive symptoms.

For non-responders — no meaningful PHQ-9 change — a within-class switch (one SSRI to another) has limited evidence and is usually skipped in favor of a cross-class switch to an SNRI or to bupropion. Each augmentation or switch is documented against the same PHQ-9 timeline used for the initial trial, so the treatment record can move directly into interventional criteria if the pharmacology does not remit the depression.

The interventional escalation pathway

After two adequate antidepressant trials at adequate dose and duration have failed to produce remission, the client meets criteria for treatment-resistant depression and, in most cases, meets insurance criteria for TMS or Spravato. The protocol at RECO Integrated Psychiatry names the interventional option at trial two rather than at trial four or five — because clients who have already spent eighteen months cycling through medications with a primary care prescriber typically arrive already at criteria and should not be asked to fail two more trials before escalation is discussed.

rTMS (repetitive transcranial magnetic stimulation) is offered as a five-to-six-week outpatient course, typically 3000 pulses per session at 120% of motor threshold to the left dorsolateral prefrontal cortex, for clients who prefer a non-medication interventional option with no systemic side effects. Spravato (esketamine nasal spray) is delivered in-office under the FDA REMS program for clients where a rapid-response option is the fit and coverage is available through their carrier. IV ketamine is offered as a cash-pay option for clients on compressed schedules where insurance timelines do not fit.

Adjunctive psychotherapy — CBT, behavioral activation, or ACT — is integrated in parallel rather than sequenced after the medication phase, because the combination outperforms either modality alone in remission and relapse-prevention data.

What to expect on your first visit

The initial psychiatric evaluation runs 60 to 75 minutes. It covers current symptoms, complete prior medication trials with dose and duration, family psychiatric history, substance use, and a suicidality assessment using the C-SSRS. Structured screens are administered — PHQ-9 for depression severity, GAD-7 for anxiety, MDQ for bipolar spectrum, and additional scales indexed to the presenting complaint. Recent labs are reviewed or ordered.

Clients leave the first visit with a documented DSM-5-TR working diagnosis, a written treatment plan, and either a prescription initiated that day or a defined next step (further workup, records request, or interventional consult). Follow-up cadence is typically two to four weeks during titration and every four to eight weeks once stable, supplemented with telepsychiatry when in-person scheduling is inconvenient.

Insurance and admissions from Delray Beach

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Benefits are verified before the first appointment so clients know their copay, deductible, and coinsurance in writing before they arrive. TMS and Spravato are prior-authorized separately with documented adequate trials from the medication phase of treatment.

Because the office is in Delray Beach itself, the drive from any neighborhood in the city — Pineapple Grove, Lake Ida, Tropic Isle, Osceola Park, or the Beach District — is under fifteen minutes, and appointments can be scheduled around work hours. Same-week intake availability is standard for adults presenting with active depressive symptoms.

Serving residents of: Pineapple Grove, Lake Ida, Tropic Isle, Beach District, Osceola Park.