Depression treatment for Fort Lauderdale — the full escalation pathway, 40 minutes away.

For adults in Las Olas, Victoria Park, and Coral Ridge, RECO Integrated Psychiatry sits 40 minutes north on I-95 in Delray Beach — the closest outpatient practice that runs SSRI and SNRI trials to adequate dose and duration, documents them properly for insurance escalation, and offers TMS, Spravato, and IV ketamine under one roof. Treatment plans are built on a documented DSM-5-TR diagnosis and a baseline PHQ-9, and the interventional pathway is named at the end of trial two — not at trial five, after another year of subtherapeutic pharmacology has gone by.

For adults living in Las Olas, Victoria Park, Coral Ridge, Rio Vista, or Wilton Manors, RECO Integrated Psychiatry’s Delray Beach office sits 26 miles north on I-95 — roughly a 40-minute commute that keeps specialist-level psychiatric care within reach without asking anyone to leave their job, their household, or their established outpatient providers behind. The practice treats major depressive disorder in the outpatient setting, from first-episode presentations that respond to a well-run SSRI trial to treatment-resistant illness that needs the full interventional pathway. Every plan is built on a documented DSM-5-TR diagnosis, a baseline PHQ-9, and a written algorithm for medication trials, augmentation, and escalation when pharmacology alone is not producing remission.

The diagnostic questions primary care does not ask

Before treating a Fort Lauderdale client for “depression,” the psychiatrist has to rule out bipolar spectrum illness. That means the Mood Disorder Questionnaire (MDQ) and the HCL-32, a structured family history, and a careful review of any prior stimulant, corticosteroid, or antidepressant exposure that produced activation, insomnia, or racing thoughts. Antidepressant monotherapy in unrecognized bipolar II or bipolar NOS reliably induces mixed states, rapid cycling, and iatrogenic worsening — the trajectory that shows up in second-opinion charts as five failed SSRIs with nobody stopping to ask why.

Other conditions present as depression and get treated as depression when they should not be. Undertreated alcohol or cannabis use disorder, subclinical hypothyroidism, obstructive sleep apnea, OCD screened via a YBOCS clinician interview, and PTSD with predominant anhedonia all mimic MDD. RECO’s intake runs the screens on the first visit — TSH and free T4, an AUDIT-C, a PC-PTSD-5, and an ASRS when attention symptoms are prominent — because catching the misdiagnosis at evaluation is the difference between a working treatment plan and four more months of trial-and-error.

First-line pharmacotherapy done well

For a clean MDD presentation the pharmacology is straightforward when it is executed correctly. An SSRI — sertraline 50 mg, escitalopram 10 mg, or fluoxetine 20 mg — or an SNRI (venlafaxine XR 75 mg, duloxetine 30 mg) is started at a starting dose, held one to two weeks to assess tolerability, then titrated to a therapeutic dose. The trial then runs a full six to eight weeks at that dose before response is judged by a repeat PHQ-9. Bupropion XL 300 mg is the first-line choice when sexual side effects, sedation, or weight gain from an SSRI would end the trial before it began. Mirtazapine 15-30 mg is used when insomnia and appetite loss are driving the presentation.

The reason so many clients arrive at RECO with “treatment-resistant depression” that is not actually treatment-resistant is that the previous trials were subtherapeutic, underdosed, or too short. Fluoxetine 20 mg for three weeks is not an adequate trial. Sertraline 50 mg held for two months without titration is not an adequate trial. Adequate dose, adequate duration, and a documented PHQ-9 at start and end are the two things insurers require before they will authorize depression treatment at the interventional tier — and the two things that scattered outpatient records almost never contain.

Augmentation and switching after partial response

Partial responders — clients whose PHQ-9 has dropped meaningfully but has not reached remission — are augmented before they are switched. The evidence base for first-line augmentation is strongest for aripiprazole 2-15 mg, lithium titrated to a serum level of 0.4-0.8 mEq/L for augmentation (lower than the mood-stabilization range), and T3 25-50 mcg. Bupropion 150-300 mg is added when residual anergia, low motivation, or cognitive slowing dominates the residual symptom profile. Quetiapine XR 150-300 mg is a reasonable option when anxiety and initial insomnia persist alongside the depressive core.

For true non-responders — clients whose PHQ-9 has not moved — a within-class switch (SSRI to another SSRI) has weak evidence and is generally not the next step. A cross-class switch — SSRI to SNRI, SSRI to bupropion, or SSRI to mirtazapine — has better evidence and is the RECO default. The distinction between augmenting a partial responder and switching a non-responder gets made at every follow-up visit, documented in the note, and referenced when the escalation conversation happens.

The interventional escalation pathway

After two adequate antidepressant trials at adequate dose and duration, a client meets the standard criteria for treatment-resistant depression — and, critically, meets the coverage criteria most insurers use to authorize TMS or Spravato. RECO’s protocol names the interventional options at the end of trial two rather than at trial four or five, because the clients who benefit most from escalation are the ones who reach it before another eighteen months of subtherapeutic pharmacology have gone by.

Repetitive transcranial magnetic stimulation is the first interventional option for clients who prefer a non-medication route. The standard course is 36 sessions over six to nine weeks, targeting the left dorsolateral prefrontal cortex at 120% of motor threshold, delivering 3,000 pulses per session at 10 Hz. Spravato (intranasal esketamine) is administered in-office under REMS monitoring — twice weekly during induction, then tapered — and is the fit for clients who need a rapid-response option or who have suicidal ideation that will not wait eight weeks for an SSRI to work. IV ketamine is available as a cash-pay option when insurance will not cover Spravato or when a compressed schedule is required.

What to expect on your first visit

The initial evaluation runs 60 to 90 minutes with a board-certified psychiatrist or psychiatric nurse practitioner. It covers a structured psychiatric history, a substance use history, a Columbia Suicide Severity Rating Scale (C-SSRS), and administration of the PHQ-9, GAD-7, MDQ, and ASRS where indicated. Labs — TSH, CBC, CMP, vitamin D, B12 — are ordered if they have not been drawn in the last six months, and prior treatment records are reviewed to establish which medications constitute adequate prior trials.

The visit ends with a written treatment plan naming the specific medication, its starting dose, target dose, and titration schedule; the follow-up cadence, typically every two to four weeks initially; and the criteria that would trigger augmentation or an interventional referral. Fort Lauderdale clients who prefer to consolidate the drive can schedule follow-ups by telepsychiatry once the plan is stable and the response is being tracked on serial PHQ-9s.

Insurance and admissions from Fort Lauderdale

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and Blue Cross Blue Shield PPO plans. Medication management is billed as standard psychiatric evaluation and management codes and typically requires only a copay after deductible. TMS and Spravato require prior authorization; the admissions team submits the documentation of adequate prior trials, tracks the utilization review, and handles the peer-to-peer conversation when a payer requests one.

For clients driving from Fort Lauderdale, the office is a straight I-95 commute — 26 miles, roughly 40 minutes off-peak and longer during rush hour. Telepsychiatry is available for follow-up visits once treatment is established, which lets clients in Las Olas, Wilton Manors, and Coral Ridge remove the round trip from a workday when in-person presence is not clinically required.

Serving residents of: Las Olas, Victoria Park, Coral Ridge, Rio Vista, Wilton Manors.