Psychiatric medication management for Boynton Beach — measurement-based, in-person.

RECO Integrated Psychiatry sits twelve minutes south of Boynton Beach on I-95, close enough that specialty psychiatric care fits inside the workweek instead of replacing it. Initial evaluations run 60 to 90 minutes and produce a documented DSM-5-TR formulation, and every follow-up is anchored to PHQ-9, GAD-7, or condition-specific scale data rather than clinical impression alone. When first-line SSRIs stall, the practice moves through augmentation with aripiprazole or lithium, cross-class switches, pharmacogenomic testing, and — where indicated — Spravato and rTMS on-site rather than referring out.

Boynton Beach sits seven miles north of Delray Beach along Federal Highway, a straight twelve-minute run south on I-95 or US-1. For adults in Renaissance Commons, Ocean Ridge, Quantum Park, or Hunters Run, the drive to RECO Integrated Psychiatry’s Delray office is shorter than the trip to most local Publix stores — brief enough that specialty psychiatric care fits inside an existing workweek rather than replacing it.

What a real psychiatric evaluation actually covers

The initial evaluation at RECO runs 60 to 90 minutes and produces a documented DSM-5-TR diagnostic formulation rather than a checklist of symptoms. History includes every prior psychotropic trial the patient can recall — the specific medication, dose, duration, and reason for discontinuation — because “sertraline didn’t work” at 25 mg for two weeks is not the same clinical fact as failing 200 mg for twelve weeks. Family psychiatric history, substance use screening, and trauma history are documented where clinically relevant.

Every adult presenting with “depression” is screened for bipolarity using the MDQ; every adult presenting with “anxiety” is screened for ADHD using the ASRS and for OCD using the Y-BOCS. Missed bipolar II and adult ADHD are two of the most common reasons SSRI monotherapy fails, and they are not reliably caught in a fifteen-minute primary-care follow-up.

Baseline labs — CBC, CMP, TSH, B12, folate, and vitamin D — are ordered where indicated, and cardiovascular history is documented before any stimulant is prescribed. This is the visit primary care does not have time to run.

Measurement-based care and why it changes outcomes

RECO delivers outpatient medication management anchored to standardized scales rather than clinical impression alone. The PHQ-9 for depression, GAD-7 for anxiety, MDQ for bipolar screening, ASRS for ADHD, PCL-5 for PTSD, and Y-BOCS for OCD are completed through the patient portal before each visit, scored inside the visit, and trended over time. Patients see their own numbers move.

The published evidence — including the STAR*D reanalyses and more recent NIMH-funded trials — is unambiguous: clinicians who anchor decisions to scale trajectories produce meaningfully better remission rates than clinicians relying on “how are you feeling today.” A PHQ-9 that has moved from 22 to 14 in six weeks is a partial response that warrants augmentation; a PHQ-9 stuck at 20 is a failed trial. Those two situations look nearly identical in an unstructured conversation.

Decisions to augment, switch, hold, or taper are documented against the scale data in the chart and reviewed with the patient at each visit.

The pharmacologic toolkit beyond the first two SSRIs

First-line pharmacotherapy is well-established and shared across psychiatry and primary care: SSRIs and SNRIs for unipolar depression and anxiety, stimulants and non-stimulants for ADHD, mood stabilizers and second-generation antipsychotics for bipolar disorder, and SSRIs plus referral for exposure and response prevention (ERP) in OCD. Most patients who reach a specialty psychiatry practice have already failed one or two of these.

The value of a psychiatrist is what happens next. Augmentation with aripiprazole, lithium, or thyroid T3; switching within the SSRI class or across to an SNRI, bupropion, mirtazapine, or vortioxetine; MAOIs where indicated; combining sertraline with buspirone for residual anxiety; adding quetiapine or olanzapine at bipolar-appropriate doses; and pharmacogenomic testing (GeneSight, Genomind) in patients with multiple failed trials or unusual side-effect patterns.

When outpatient pharmacology has been genuinely exhausted, escalation to interventional treatment — Spravato (esketamine) for treatment-resistant depression, or rTMS delivered at 120% of motor threshold across the standard 3,000-pulse protocol — is offered on-site rather than referred out.

Monitoring: the labs, the metabolic panel, the drug levels

Psychiatric medications require ongoing biological monitoring, and the specific monitoring depends on the drug. Lithium requires baseline TSH, creatinine, and calcium, plus a twelve-hour post-dose serum level repeated quarterly once stable. Second-generation antipsychotics — quetiapine, olanzapine, aripiprazole, risperidone — require a baseline metabolic panel with HbA1c, fasting lipids, weight, and blood pressure, then repeat at three months and annually.

Valproate requires baseline LFTs, CBC with platelets, and serum levels within the therapeutic window. Stimulants require documented cardiovascular history and a blood-pressure and heart-rate check at each visit. SSRIs in patients over 65 or on other QT-prolonging medications warrant a baseline ECG.

RECO’s protocol builds these into the visit cadence, so nothing gets missed because the patient did not know to ask for it.

What to expect on your first visit

The intake is 60 to 90 minutes, in person at the Delray Beach office. Patients complete PHQ-9, GAD-7, and — where indicated — MDQ, ASRS, PCL-5, or Y-BOCS through the patient portal beforehand so the scored data is available from the start of the visit rather than eaten into it.

The psychiatrist reviews presenting concerns, prior treatment history, current medications, and family history; performs a mental status examination; formulates a working DSM-5-TR diagnosis; and discusses a written treatment plan. If a medication change is indicated, it is initiated the same day with a cross-titration schedule where relevant.

Follow-up visits are typically 30 minutes and occur every two to four weeks during titration, then every four to twelve weeks in maintenance. Adjunctive psychotherapy — CBT, DBT, ACT, EMDR, or motivational interviewing — is coordinated with in-network therapists in the Boynton Beach and Delray corridor.

Insurance and admissions from Boynton Beach

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Benefits — specifically the specialist copay, remaining deductible, and coinsurance for psychiatric evaluation (CPT 90792) and follow-up management (CPT 99214 with the 90833 psychotherapy add-on) — are verified before the first visit and quoted in writing. Plans requiring a PCP referral for specialty psychiatry are flagged before scheduling.

For Boynton Beach residents, the office is a twelve-minute drive south on I-95 or Federal Highway. Telepsychiatry follow-ups are available for established patients on stable regimens; initial evaluations and interventional treatments (Spravato, rTMS) are in-person. Same-week new-patient appointments are typical.

Serving residents of: Renaissance Commons, Ocean Ridge, Quantum Park, Hunters Run, Briny Breezes.