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

RECO Integrated Psychiatry is 18 minutes from Lantana down Federal Highway — the closest outpatient practice north of Broward that runs full 60-to-90-minute DSM-5-TR evaluations, measurement-based follow-ups anchored to PHQ-9 and GAD-7 trajectories, and the entire pharmacologic algorithm beyond first-line SSRIs. For Hypoluxo Island, Manalapan, and Ocean Ridge residents whose primary care physician has run out of options at sertraline plus bupropion, RECO's psychiatrists move through augmentation with aripiprazole or lithium, class switches, MAOIs, and pharmacogenomic testing where indicated. Interventional options — rTMS and Spravato — are available in the same practice when medications alone stall out.

Lantana and Hypoluxo Island sit in a quiet stretch between Delray Beach and West Palm Beach — barrier-island neighborhoods where residents can drive Federal Highway or A1A to reach specialist care in either direction. RECO Integrated Psychiatry’s Delray Beach office is 18 minutes south, roughly 11 miles down US-1. For adults in Lantana, Manalapan, Ocean Ridge, and Old Town Lantana, it is the closest outpatient practice offering psychiatrist-led medication management with the diagnostic depth and follow-up structure that a 15-minute primary care visit cannot accommodate.

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 — not a symptom checklist forwarded to the pharmacy. History-taking covers every prior psychiatric medication trial by name, dose, duration, and the specific reason each was discontinued: nonresponse at an adequate trial, adverse effect, cost, or premature discontinuation before six to eight weeks. Family psychiatric history is mapped across first- and second-degree relatives, because a maternal aunt with bipolar I substantially changes the risk profile of antidepressant monotherapy.

Every patient presenting with “depression” or “anxiety” is screened for bipolarity with the MDQ, for adult ADHD with the ASRS, and for OCD symptoms with abbreviated Y-BOCS items. This matters because a meaningful minority of patients carrying a unipolar depression label meet criteria for bipolar II when a structured interview is used, and treating bipolar depression with an SSRI alone is a well-documented way to induce a mixed state or hypomania. Substance use is screened with AUDIT-C and a brief drug questionnaire; a positive screen triggers an ASAM Criteria-informed assessment before any controlled substance is prescribed.

Baseline labs — CBC, CMP, TSH, B12 and folate, vitamin D, and HbA1c where indicated — are ordered where clinically warranted. Thyroid dysfunction, B12 deficiency, and anemia all present as fatigue, cognitive slowing, and low mood, and none of them respond to sertraline. This is the visit primary care does not have time to run.

Measurement-based care and why it changes outcomes

PHQ-9 for depression, GAD-7 for anxiety, MDQ for bipolar screening, ASRS for adult ADHD, and Y-BOCS for OCD are completed through the patient portal before each visit, scored during the visit, and trended over time. The published literature — including the STAR*D re-analyses and subsequent measurement-based care trials — is unambiguous: symptom rating scales anchored to visits produce meaningfully better remission rates than clinical impression alone, largely by surfacing partial responders who feel “better” but remain above the remission threshold of a PHQ-9 below 5.

Medication decisions at RECO are anchored to the scale trajectory rather than to whether a patient reports feeling better on the day of the visit. A PHQ-9 that has moved from 22 to 14 is a partial response, not a treatment success, and it triggers augmentation or dose optimization rather than a maintenance conversation. A GAD-7 that has not moved after eight weeks at a therapeutic dose triggers a class switch, not another dose increase. This structure removes the drift that accumulates in unmeasured practice, where visits blur together and the trajectory is reconstructed from memory.

The pharmacologic toolkit beyond the first two SSRIs

First-line pharmacotherapy is well-established: SSRIs and SNRIs for mood and anxiety disorders, stimulants and non-stimulants for ADHD, mood stabilizers and second-generation antipsychotics for bipolar disorder, and SSRIs plus a referral for exposure and response prevention (ERP) for OCD. Most patients respond to a competently prescribed first-line agent at an adequate dose for an adequate duration. The value of specialty psychiatric care is what happens after the first two SSRIs have not worked.

Treatment-resistant depression protocols include augmentation with aripiprazole (2 to 15 mg), lithium at a target trough of 0.6 to 0.8 mEq/L, thyroid hormone (T3 25 to 50 mcg), and buspirone; switching within class (sertraline to escitalopram) versus across class (SSRI to an SNRI like venlafaxine or duloxetine, to bupropion, to mirtazapine); MAOIs in genuinely refractory cases with appropriate washout and tyramine counseling; and pharmacogenomic testing (GeneSight, Genomind) in patients with multiple failed trials or intolerable side effects.

When medications alone are insufficient, RECO’s psychiatrists escalate to interventional options — rTMS at 3000 pulses per session at 120 percent motor threshold over the left DLPFC for major depression, or esketamine (Spravato) for treatment-resistant depression under REMS monitoring — rather than cycling indefinitely through oral trials. Coordinated psychotherapy referrals (CBT, DBT, ACT, EMDR for trauma-related presentations, motivational interviewing where ambivalence about treatment is prominent) run in parallel where indicated.

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

Lithium requires baseline TSH, creatinine, and calcium, followed by trough levels drawn 12 hours post-dose at week one, week four, and quarterly thereafter, with periodic renal and thyroid function. Valproate requires baseline LFTs, CBC with platelets, and a trough level at steady state, with LFTs and platelets repeated periodically. These are not optional. Missed lithium monitoring is a documented pathway to preventable nephrogenic diabetes insipidus and chronic kidney disease.

Second-generation antipsychotics — aripiprazole, quetiapine, olanzapine, risperidone — require baseline weight, blood pressure, fasting glucose or HbA1c, and a lipid panel, with the metabolic panel repeated at 12 weeks and annually per APA and ADA consensus. Olanzapine and quetiapine carry the highest metabolic burden and are used more selectively for that reason. Stimulants require a cardiovascular history, resting blood pressure and heart rate at every visit, and an ECG in patients with cardiac risk factors before initiation.

RECO’s protocol builds these into the visit cadence so nothing gets missed because a patient did not remember to ask. Lab orders are placed before they are due, the record flags overdue monitoring, and results are reviewed against thresholds rather than filed.

What to expect on your first visit

New patients complete intake paperwork and baseline rating scales (PHQ-9, GAD-7, MDQ, ASRS) through the portal in the days before the appointment. A records release is sent to prior prescribers where the patient has been on multiple trials, so the psychiatrist has an accurate trial history rather than a reconstructed one. The evaluation itself runs 60 to 90 minutes and is conducted in person at the Delray Beach office or, where clinically appropriate, via secure telepsychiatry.

The visit produces a written diagnostic formulation, a treatment plan with target symptoms and rating-scale goals, a prescription where indicated, and any relevant lab orders. Follow-up cadence is typically two to four weeks during titration and every four to twelve weeks in maintenance, depending on the agent. Controlled substance prescribing — stimulants, benzodiazepines — requires PDMP review, urine drug screening on a defined schedule, and a signed controlled substance agreement.

Insurance and admissions from Lantana

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans through the Blue Card network. Outpatient psychiatric evaluation (CPT 90792) and follow-up medication management (99213 through 99215, with add-on 90833 where brief psychotherapy is documented) are standard benefits under federal and Florida mental health parity. Out-of-pocket cost is determined by the plan’s copay, coinsurance, and deductible structure rather than by diagnosis.

New-patient intake typically takes two to five business days from the initial call, and the admissions coordinator verifies benefits before the first visit so patients know their financial responsibility in advance. From Lantana, the drive is 18 minutes down Federal Highway or slightly less along A1A for Hypoluxo Island, Manalapan, and Ocean Ridge residents; parking is on site.

Serving residents of: Hypoluxo Island, Manalapan, Ocean Ridge, Old Town Lantana.