TMS therapy for Boca Raton — FDA-cleared TRD care, 20 minutes from home.

RECO Health's Delray Beach campus is a 20-minute drive up Federal Highway from Mizner Park, which makes a six-week daily rTMS course practical without relocating or interrupting work. Treatment is delivered on the FDA-cleared 36-session protocol at 120% of motor threshold over the left dorsolateral prefrontal cortex, with iTBS and deep TMS available where clinically indicated. In-house psychiatry manages candidacy, prior authorization, and concurrent medication or psychotherapy — the rTMS chair is one part of an integrated treatment plan, not a standalone service.

From Mizner Park or Royal Palm Place, the drive up Federal Highway to RECO Health’s Delray Beach campus takes roughly 20 minutes — shorter than most Palm Beach County morning commutes and short enough that a six-week daily treatment schedule fits inside an ordinary life rather than requiring a temporary relocation. That matters for repetitive transcranial magnetic stimulation, which by protocol demands Monday-through-Friday attendance for the first thirty sessions. RECO Health delivers the FDA-cleared rTMS treatment protocol for treatment-resistant major depressive disorder, with deep TMS available for OCD, staffed by an in-house psychiatry team and integrated with the wider continuum of detox, residential, PHP, and IOP care.

Who is a candidate for rTMS

The insurance-covered indication for rTMS is major depressive disorder with documented failure of at least two adequate antidepressant trials. “Adequate” carries a specific meaning under commercial payer criteria: therapeutic dose, minimum six-to-eight-week duration, and documented adherence. Common documentation includes an SSRI or SNRI trial (for instance sertraline titrated to 150-200 mg, or venlafaxine XR to 225 mg) and a second-line trial with an augmentation strategy — aripiprazole, quetiapine, lithium, or a switch to bupropion. RECO’s psychiatry team reconstructs and documents this history during intake so the prior authorization submission reflects what payers actually require.

Clinical candidacy extends beyond the payer checklist. Screening covers absolute contraindications — ferromagnetic implants near the head, cochlear implants, deep brain stimulators — and relative contraindications, including a personal or family history of seizures, active substance use, and unstable bipolar illness. Baseline measurement uses the PHQ-9 for depression severity, the GAD-7 for comorbid anxiety, and the YBOCS when OCD is the target indication for deep TMS. Bipolar spectrum is screened with the MDQ; ADHD comorbidity is assessed with the ASRS when relevant to the treatment plan.

The 36-session protocol and what it actually looks like

Session one is motor threshold mapping. A trained technician positions the figure-8 coil over the primary motor cortex and delivers single pulses at increasing intensity until a reliable thumb twitch appears — the resting motor threshold. Treatment intensity is then set at 120% of that value, and the coil is repositioned five to six centimeters anteriorly to target the left dorsolateral prefrontal cortex. The standard protocol delivers 3,000 pulses per session at 10 Hz — four-second trains separated by 26-second intertrain intervals — over roughly 20 to 40 minutes depending on the exact parameters.

Sessions two through thirty are daily Monday through Friday for six weeks. Clients are awake, seated, and can talk, read, or watch a screen during the treatment. The final six sessions form a structured taper: three per week, then two per week, then one per week. There is no sedation, no post-procedure recovery period, no driving restriction. Clients typically report mild scalp discomfort and occasional tension-type headache in the first week, both of which attenuate. A rare but real risk of provoked seizure — approximately 1 in 30,000 sessions — is why seizure history and lowering-threshold medications are screened at intake.

Response, remission, and the second-course question

Published response rates for rTMS in treatment-resistant depression run 40-60% and remission rates 25-40%, varying with how strictly the population is defined and which protocol is used. RECO tracks the PHQ-9 weekly through treatment; a 50% reduction from baseline defines response, and a score below 5 defines remission. Response typically emerges between sessions 15 and 25, with continued symptomatic gains during the three-week taper. Early responders are common; a small subset of clients respond only during the taper phase, which is one reason the full 36-session course is not truncated when symptoms lag.

Non-responders at session 20-25 are formally re-evaluated. Options include repositioning the coil using a Beam F3 or neuronavigation-guided target, switching from 10 Hz rTMS to an intermittent theta burst protocol, or transitioning the case to the ketamine or esketamine pathway when the phenotype and prior trials suggest better fit there. Responders who relapse are candidates for a second full course, typically 12-18 months after the first, and increasingly for scheduled maintenance sessions in high-recurrence cases. Psychiatry, not the technician, drives these decisions.

iTBS and the shorter-session option

Intermittent Theta Burst Stimulation is an FDA-cleared alternative rTMS protocol delivering 600 pulses in a three-minute session — bursts of three pulses at 50 Hz repeated at 5 Hz — targeting the same left DLPFC location. The non-inferiority evidence, most notably the THREE-D trial, supports iTBS as equivalent in efficacy to conventional 10 Hz rTMS in treatment-resistant depression. For clients whose work schedule cannot absorb a 45-minute daily treatment window, iTBS makes a six-week daily protocol feasible without weakening the evidence base.

Coverage differs by plan. Some commercial payers reimburse iTBS at parity with conventional rTMS; others carve it out or require additional documentation. The psychiatry team confirms the specific benefit language before enrollment rather than after, so a candidate who is planning around a shorter session isn’t surprised at session five. Deep TMS on the H1 or H7 coil, used for OCD and select depression cases, is a separate platform with its own session parameters and prior authorization pathway.

What to expect on the first visit

The first appointment is a psychiatric evaluation rather than a treatment. The intake psychiatrist reconstructs prior medication trials with dose and duration, screens for bipolar spectrum and psychotic features, reviews current medications for seizure-threshold interactions (bupropion, clozapine, tramadol), and administers the PHQ-9, GAD-7, and Columbia Suicide Severity Rating Scale. Comorbid substance use is triaged against ASAM Criteria dimensions; active alcohol or benzodiazepine dependence generally requires stabilization before rTMS initiation.

Concurrent psychotherapy is typical during the treatment course — most commonly CBT or ACT for depression, with EMDR available when trauma is a driver and behavioral activation embedded in the first weeks. Motor threshold mapping is scheduled once prior authorization returns approved, generally within one to two weeks of intake. Clients drive themselves to and from every session and continue full-time work throughout.

Insurance and admissions from Boca Raton

RECO Health is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans, and processes the rTMS prior authorization on the client’s behalf. The determining question for coverage is not diagnosis alone but documented trial history — the admissions and psychiatry teams work directly with prior prescribers to obtain the pharmacy and clinical records that payers require. Motor threshold mapping is scheduled once approval returns, and daily treatment begins the following week.

For families and clients in Boca Raton, Highland Beach, Boca West, or the Downtown Boca corridor, the operational reality is that daily attendance at the Delray campus is compatible with continued work, school, and childcare. Admissions confirms insurance, requests the prior treatment records, and schedules the psychiatric evaluation, typically within a week of first contact.

Serving residents of: Mizner Park, Royal Palm Place, Downtown Boca, Boca West, Highland Beach.