TMS therapy for Wellington — outpatient TRD care, 38 minutes from home.

RECO Integrated Psychiatry runs an outpatient-only psychiatric clinic 38 minutes east of Wellington's Palm Beach Polo, Olympia, and Aero Club neighborhoods, delivering both standard 10 Hz TMS and three-minute iTBS on FDA-cleared protocols for treatment-resistant depression and Brainsway H7 deep TMS for OCD. Prior authorization for Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans is handled by the practice, not the client, and morning and late-afternoon blocks are reserved first for out-of-area cases. There is no PHP intake, no facility fee, and no residential enrollment — the entire course is delivered in the Delray Beach office.

Wellington sits 28 miles west of RECO Integrated Psychiatry’s Delray Beach office — about 38 minutes by car through the equestrian corridor that wraps Palm Beach Polo, Olympia, Aero Club, Versailles, and Wellington View. For a treatment course that requires five outpatient visits per week across six to nine weeks, that commute is the central logistical question. RECO’s psychiatry clinic is an outpatient-only site built around TMS therapy, Spravato, and medication management — no PHP intake, no facility fee, no residential lift-and-shift, and appointment blocks scheduled to avoid Southern Boulevard rush hour.

Insurance-covered TRD candidacy and how RECO documents it

Commercial coverage for repetitive TMS in major depressive disorder is gated on treatment-resistant depression criteria that every major carrier — Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans — codifies in roughly the same shape. The client must have failed at least two antidepressant trials at adequate dose and adequate duration, usually six weeks or more, with documented adherence. Trials typically span an SSRI (sertraline, escitalopram) and an SNRI (venlafaxine, duloxetine), often with augmentation using aripiprazole, quetiapine, lithium, or buspirone. A course of evidence-based psychotherapy — CBT, ACT, or interpersonal — is a near-universal additional requirement.

The intake at RECO Integrated Psychiatry reconstructs treatment history in the exact format the payer requires. When prior prescriptions are scattered across three or four clinicians, pharmacy records are pulled and cross-referenced with the client’s account of dose and duration; the PHQ-9 is administered at baseline and again at each authorization checkpoint. Prior authorization is submitted by the practice, not the client, and average turnaround for the plans listed above runs five to ten business days.

Motor threshold mapping and the first week of treatment

Session one is motor threshold determination, not a treatment session. The clinician locates the primary motor cortex representation of the right abductor pollicis brevis and titrates stimulator output until a visible thumb twitch is evoked on five of ten pulses at rest. Treatment intensity is then set at 120% of that motor threshold — the FDA-cleared standard for the NeuroStar and MagVenture protocols in use. Motor threshold is re-measured periodically because scalp-to-cortex distance and antidepressant status can shift the number.

Sessions two through five deliver the full 3,000-pulse, 10 Hz protocol over the left dorsolateral prefrontal cortex (DLPFC) with a 4-second on, 26-second off duty cycle. Scalp discomfort and mild jaw muscle activation are most prominent in the first week and typically desensitize by session six or seven. There is no sedation, no post-session monitoring, and no driving restriction — Wellington clients routinely return to work, ride, or resume Wellington View school pickup within an hour of the appointment.

Standard 10 Hz versus intermittent theta burst (iTBS)

The 10 Hz protocol runs 20 to 40 minutes per treatment depending on coil and pulse count. Intermittent theta burst stimulation (iTBS) — cleared by FDA on the strength of the THREE-D trial — delivers equivalent antidepressant efficacy in a three-minute session. For a Wellington professional who cannot budget forty-five minutes daily for six weeks, iTBS is often the difference between completing the course and dropping out at session twelve.

Not every commercial plan reimburses iTBS at the same rate as standard 10 Hz, and some plans still require a documented 10 Hz failure before authorizing theta burst. RECO’s psychiatry team confirms coverage in writing before scheduling and, when iTBS is denied, structures the standard protocol around the client’s work calendar rather than the reverse.

Response, taper, and the retreatment question

Published rTMS response rates in TRD run 40 to 60 percent; remission rates 25 to 40 percent. Response typically emerges between sessions 15 and 25 — the PHQ-9 is repeated every five sessions, and a drop of five or more points on two consecutive administrations is the clinical marker most payers accept as documented response. Non-responders at session 20 are re-evaluated: sometimes the target is remapped (F3 versus Beam F3 heuristics), sometimes augmentation is added or switched, sometimes the client is transitioned to esketamine (Spravato) under the same roof.

The final six sessions of the acute course are a structured taper — three per week, then two, then one — designed to reduce early relapse risk rather than a marketing flourish. Responders who relapse in the six-to-twelve-month window post-treatment are candidates for a second full course; commercial insurance typically covers retreatment on documentation of prior response and a current PHQ-9 consistent with relapse. RECO tracks its own response cohort and does not schedule a retreatment course without an objective floor.

Deep TMS for OCD on the Brainsway H7 platform

For obsessive-compulsive disorder, RECO delivers deep TMS on the Brainsway H7 coil — FDA-cleared for OCD in 2018 and structured differently from the depression protocol. The H7 field reaches the medial prefrontal cortex and anterior cingulate rather than the DLPFC; treatment follows a brief individualized symptom provocation immediately prior to each session, and course length is 29 sessions over six weeks. The Y-BOCS is administered at baseline, mid-course, and end-of-course, with a 30 percent reduction the benchmark for clinical response.

OCD candidacy at RECO requires two failed SSRI trials at OCD-range doses (fluoxetine 60–80 mg, sertraline 200 mg, fluvoxamine 300 mg) plus a course of exposure and response prevention (ERP). Deep TMS does not replace ERP; when clients arrive without prior ERP experience, RECO refers to a specialty ERP therapist and begins TMS concurrently rather than sequentially.

Getting to RECO from Wellington and what the first visit looks like

The 38-minute drive from Wellington to RECO’s Delray Beach office typically runs east on Forest Hill or Southern Boulevard to Florida’s Turnpike, then south to Atlantic Avenue. Morning blocks (7 to 9 a.m.) and late-afternoon blocks (4 to 6 p.m.) are the most requested TMS windows and are reserved first for out-of-area clients. Sober-living network partners exist for clients who prefer to consolidate the first two weeks of daily sessions locally in Delray before returning to a Wellington commute — an option most often used by clients arriving with significant sleep disruption or postpartum depression.

The initial consultation is a 60-to-90-minute psychiatric evaluation: full pharmacologic history, PHQ-9, GAD-7, and where relevant the ASRS or Y-BOCS. Prior authorization is initiated the same day. Motor threshold mapping is scheduled as a separate 30-minute visit once coverage is confirmed, and the first treatment session usually follows within a week of the mapping.

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