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

RECO Integrated Psychiatry is a full-time outpatient psychiatry practice in Delray Beach — about 65 minutes from Brickell and Coral Gables up I-95, with most Miami-based follow-up delivered by Florida-compliant telepsychiatry after the in-person evaluation. Initial visits run 60 to 90 minutes with a psychiatrist rather than a triage clinician, every visit is anchored to standardized scales (PHQ-9, GAD-7, MDQ, ASRS, Y-BOCS), and the treatment algorithm continues past the SSRI-plus-bupropion combination where most 15-minute refill visits stop. For treatment-resistant cases, rTMS and Spravato are available on-site with the prior-authorization work handled by admissions.

Miami psychiatric patients face a specific geographic reality — specialist psychiatry with genuine algorithmic depth is thinner on the ground than the metro’s cardiology or neurology bench would suggest, and the drive from Brickell or Coral Gables up I-95 to RECO Integrated Psychiatry’s Delray Beach office runs about 65 minutes each way. For adults who need more than a rushed 15-minute refill visit but who do not require residential treatment, that hour buys access to a full-time outpatient psychiatry practice with measurement-based follow-up and the pharmacologic toolkit to work through complex or treatment-resistant presentations. RECO provides outpatient psychiatric medication management to clients from Brickell, Coral Gables, Coconut Grove, Aventura, and Pinecrest, with most follow-up delivered by Florida-compliant telepsychiatry after the initial in-person evaluation.

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 list handed off to a refill algorithm. History covers every prior medication trial with dose, duration, and specific reason for discontinuation, because a client who “failed sertraline” at 25 mg for three weeks did not adequately trial sertraline. Family psychiatric history, substance use screening, and trauma history are gathered where clinically relevant, and adverse childhood experiences are documented rather than glossed.

Every adult presenting with “depression” or “anxiety” is screened for bipolar spectrum illness with the MDQ, for adult ADHD with the ASRS, and for OCD with the Y-BOCS. Missed bipolarity in a client treated with antidepressant monotherapy is a common and consequential error — it accelerates cycling and can precipitate manic switch. ADHD and OCD are frequently comorbid with the presenting complaint and each requires distinct pharmacologic management.

Baseline laboratory workup is ordered where indicated — CBC, CMP, TSH, B12, folate, and vitamin D catch the hypothyroidism, anemia, and B12 deficiency that mimic or worsen depressive presentations. Where clinical suspicion exists, a fasting metabolic panel and HbA1c anchor future monitoring. This is the evaluation primary care does not have time to run.

Measurement-based care and why it changes outcomes

Every visit at RECO is anchored to standardized instruments — PHQ-9 for depression, GAD-7 for anxiety, MDQ for bipolar screening, ASRS for adult ADHD, Y-BOCS for OCD — completed by the client before the visit and scored during the visit. Scores are trended over time in the chart, so a client whose PHQ-9 has moved from 22 to 14 to 9 has documented remission progress even when the subjective report is “I don’t know, some days are fine.”

Published trial data on measurement-based care in depression is consistent: structured scale-driven follow-up produces meaningfully better response and remission rates than clinical impression alone. It also protects against the drift that occurs when a client with treatment-resistant depression is left on the same SSRI at the same dose for two years because nobody wrote down the starting number.

Decisions to augment, switch, or refer for interventional treatment are anchored to the trajectory of the score. A client whose GAD-7 has plateaued at 12 after eight weeks on an adequate SNRI dose is a client for whom the next step is a specific augmentation or switch decision, not another dose increase past the therapeutic ceiling.

The pharmacologic toolkit beyond the first two SSRIs

First-line pharmacotherapy is well-established and not the point of a specialty psychiatry visit: SSRIs and SNRIs for unipolar depression and anxiety disorders, stimulants and non-stimulants for ADHD, mood stabilizers such as lithium or lamotrigine and second-generation antipsychotics for bipolar disorder, and SSRIs paired with a referral for exposure and response prevention for OCD. The value of a specialist appears at step two and beyond.

That toolkit includes augmentation with aripiprazole, quetiapine, lithium, or T3 in resistant depression; switching within class (sertraline to escitalopram) or across class (SNRI to bupropion, mirtazapine, or a tricyclic); MAOIs where appropriate with the dietary and washout counseling that requires; pharmacogenomic testing (GeneSight, Genomind) in genuinely complex cases rather than as a routine upsell; and appropriate escalation to esketamine (Spravato) or repetitive TMS when two adequate trials have failed.

Anxiety disorders benefit from a similar toolkit approach — buspirone augmentation, hydroxyzine for as-needed use, time-limited benzodiazepine bridging where clinically appropriate, and coordinated CBT or ACT referral. RECO’s psychiatrists work through the algorithm rather than stalling on the same SSRI-plus-bupropion combination for years.

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

Every medication class carries its own monitoring obligation, and specialty psychiatry runs them on schedule. Lithium requires baseline TSH, creatinine, and calcium, quarterly lithium levels, and periodic renal and thyroid rechecks; the therapeutic window is narrow and the consequences of missing it are lasting. Valproate requires baseline LFTs and platelets, valproate levels, and repeat LFTs at intervals. Carbamazepine requires baseline CBC and LFTs plus levels and induction monitoring.

Second-generation antipsychotics — quetiapine, olanzapine, aripiprazole, risperidone — require baseline weight, waist circumference, blood pressure, fasting glucose or HbA1c, and lipid panel, with annual metabolic reassessment per APA guidance. Stimulants require documented cardiovascular history plus blood pressure and pulse at each visit. Naltrexone requires baseline LFTs where indicated; any office-based buprenorphine bridge is COWS-anchored at induction.

RECO’s visit protocols build these checks into the cadence so nothing is skipped because the client did not think to ask about it. Labs are ordered through in-network laboratories where possible to minimize out-of-pocket cost for Miami clients on Florida Blue, Aetna, and comparable commercial plans.

What the first visit produces and how follow-up is structured

The initial evaluation is scheduled for 60 to 90 minutes with a board-certified or board-eligible psychiatrist. Clients complete demographic intake and the relevant symptom scales in advance. The visit produces a written formulation, a specific pharmacologic plan with informed-consent documentation of expected onset, side effects, and monitoring obligations, and a follow-up interval calibrated to the medication chosen and the acuity — typically two to four weeks during any titration and every four to eight weeks once the regimen is stable.

Concurrent evidence-based psychotherapy is a standard recommendation and coordinated through in-network referral where clients are not already established. CBT for anxiety and depression, DBT skills for emotion dysregulation, EMDR for trauma-focused work, ACT for chronic and treatment-resistant presentations, and MI for ambivalent substance-use presentations all pair predictably with pharmacotherapy. Where indicated, RECO refers directly for TMS, Spravato, or a higher level of care.

Insurance and admissions from Miami

RECO Integrated Psychiatry is in-network with the major commercial carriers most Miami-area clients hold — Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Benefits are verified before the first visit, and admissions quotes the specific copay or coinsurance for the initial evaluation (CPT 90792) and for standard follow-up medication management visits (CPT 99213 or 99214, with a 90833 psychotherapy add-on when psychotherapy is delivered).

For Miami clients whose treatment plan escalates to rTMS or Spravato, the first prior-authorization cycle is initiated at the evaluation rather than left to the client to chase down. Most follow-up visits after the initial in-person evaluation are conducted by telepsychiatry under Florida telehealth rules, which removes the routine 65-minute I-95 commute from ongoing medication management for clients in Brickell, Aventura, and Coral Gables.

Serving residents of: Brickell, Coral Gables, Coconut Grove, Aventura, Pinecrest.