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

RECO Integrated Psychiatry sits about 38 minutes east of Wellington in Delray Beach, offering specialist-level medication management that a 15-minute primary care slot cannot deliver. Initial evaluations run 60 to 90 minutes, produce a documented DSM-5-TR formulation, and are followed by measurement-based care using PHQ-9, GAD-7, MDQ, ASRS, and Y-BOCS anchored to serial outcome data. For treatment-resistant depression, TMS at 120% of motor threshold and Spravato are available on-site rather than referred out, so the entire algorithm — from first-line SSRI through augmentation, switch, and interventional care — lives inside one clinical relationship.

Wellington sits 28 miles west of RECO Integrated Psychiatry’s Delray Beach practice — roughly 38 minutes by car via Southern Boulevard or Lake Worth Road. For adults in Olympia, Versailles, Aero Club, Palm Beach Polo, and Wellington View who need specialist-level medication management rather than another 15-minute refill visit, the drive replaces months of trial-and-error with a documented DSM-5-TR formulation and a treatment plan anchored to serial outcome data rather than to whether the client “feels better today.”

What a real psychiatric evaluation actually covers

The initial visit at RECO Integrated Psychiatry runs 60 to 90 minutes with a psychiatrist and produces a documented DSM-5-TR diagnostic formulation — not a symptom checklist and not a five-line note. History includes every prior psychiatric medication with dose, duration, response, and the specific reason for discontinuation. Family psychiatric history is mapped to first- and second-degree relatives. A substance use screen is standard, and trauma history is taken where clinically indicated.

Anyone presenting with “depression” is screened for bipolarity with the MDQ before an SSRI is written; anyone presenting with “anxiety” is screened for OCD with the Y-BOCS and for adult ADHD with the ASRS. Untreated ADHD in adults looks almost identical to generalized anxiety, and unrecognized bipolar II turns SSRIs into mood destabilizers. This is diagnostic work that a 15-minute primary care visit is not built to do.

Baseline labs are ordered where the clinical picture requires them — CBC, CMP, TSH, B12, folate, and vitamin D — before starting or adjusting medication. Thyroid disease and B12 deficiency both mimic mood disorders, and a stimulant prescription written without a cardiovascular history is a documentation problem waiting to happen.

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 before every appointment, scored during the visit, and tracked across the full course of treatment. The evidence for measurement-based care is not controversial: patients whose medication decisions are anchored to serial rating-scale data reach remission faster and more reliably than patients whose clinicians work from clinical impression alone.

Concretely: a PHQ-9 dropping from 18 to 14 over six weeks on sertraline 100 mg is a partial response that warrants dose escalation, augmentation with aripiprazole, or a switch to an SNRI — not another “let’s give it more time.” A GAD-7 that plateaus at 12 after buspirone augmentation triggers a different conversation than a GAD-7 that plateaus at 4. Scales are what let a psychiatrist distinguish “the medication is working slowly” from “the medication is not working.”

For Wellington clients, scales are also completed remotely between visits, which shortens the feedback loop and prevents a 38-minute drive from becoming the rate-limiting step in a dose adjustment.

The pharmacologic toolkit beyond the first two SSRIs

First-line pharmacotherapy is well-established and rarely the problem — SSRIs and SNRIs for mood and anxiety, stimulants and non-stimulants for ADHD, mood stabilizers and atypicals for bipolar disorder, SSRIs plus ERP referral for OCD. The clinical value of specialty psychiatry shows up after first-line fails, which it does in roughly a third of cases.

RECO’s psychiatrists move through a STAR*D-style algorithm rather than getting stuck at step two. Augmentation strategies include aripiprazole, lithium, and T3 thyroid; switching happens both within and across drug classes; MAOIs are used where indicated by history; pharmacogenomic testing with GeneSight or Genomind is ordered in genuinely complex cases rather than as a default; and escalation to interventional treatment — rTMS at 120% of motor threshold or Spravato (esketamine) — is offered on-site rather than referred out. This is the core of our approach to psychiatric medication management.

For bipolar disorder, lithium remains first-line for classic presentations, with lamotrigine, quetiapine, and lurasidone for depressive phases and olanzapine or divalproex for acute mania. For treatment-resistant anxiety, options extend beyond SSRIs to buspirone, hydroxyzine, and gabapentinoids in selected cases, paired with structured CBT, ACT, or EMDR referral where trauma is driving the presentation.

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

Every psychiatric medication carries a monitoring protocol, and the most common failure mode of long-term prescribing is that the protocol quietly stops after month three.

Lithium requires baseline and periodic TSH, creatinine, and calcium, with a quarterly lithium level drawn twelve hours post-dose once the dose is stable. Atypical antipsychotics — aripiprazole, quetiapine, olanzapine, lurasidone — require baseline and annual metabolic panels: fasting glucose or HbA1c, lipid panel, weight, waist circumference, and blood pressure. Valproate requires baseline LFTs, platelets, and periodic serum levels. Stimulants require a cardiovascular history at intake and blood pressure plus heart rate at every follow-up.

RECO builds these into visit cadence rather than relying on the client to remember to ask. Standing orders route labs to a nearby Quest or LabCorp — several within a short drive of Wellington — so specimens are drawn before the visit and results are reviewed with the client, not filed unread.

What to expect on your first visit

The intake packet is completed online before the appointment: symptom history, medication history, PHQ-9, GAD-7, MDQ, ASRS, and a substance use screen. The initial visit itself runs 60 to 90 minutes with a psychiatrist — not a rooming nurse followed by a brief prescriber touch — and ends with a written diagnostic formulation, a treatment plan, and a clear next step: labs to run, medication to start or adjust, and a follow-up interval that is typically two to four weeks for new starts.

Follow-up visits are 25 to 30 minutes and are structured around scale data, side effects, and interval events. For Wellington clients who prefer to reduce driving, follow-ups can be conducted via telepsychiatry across Florida once the diagnostic relationship is established in person.

Insurance and admissions from Wellington

RECO Integrated Psychiatry works with most major commercial plans, including Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Benefits are verified before the first appointment and clients receive a written out-of-pocket estimate — deductible, copay, and coinsurance — before intake so cost is not a surprise at check-in.

Admissions from Wellington typically move from an initial phone screen to a scheduled evaluation within one to two weeks. Urgent cases — active suicidality, medication crises, or acute manic presentations — are triaged same-day and either scheduled expedited or routed to a higher level of care. The Delray Beach office is a straight shot east on Southern Boulevard or Lake Worth Road, roughly 38 minutes door to door in typical Palm Beach County traffic.

Serving residents of: Olympia, Versailles, Aero Club, Palm Beach Polo, Wellington View.