TMS therapy for Jupiter — FDA-cleared TRD care, 45 minutes from home.

RECO Health runs a full in-house TMS program 32 miles south of Jupiter — motor threshold mapping, the FDA-cleared 36-session rTMS protocol at 120% MT over the left DLPFC, and iTBS for clients who need a three-minute alternative to the standard 20-40 minute session. Psychiatry, prior authorization, and concurrent CBT or ACT run under one roof, so a Jupiter client isn't coordinating between a mapping site, a treatment site, and an outside prescriber. For Abacoa and Jupiter Inlet Colony families, the 45-minute drive is short enough to sustain daily treatment and long enough to put clinical work outside the local trigger environment.

From Jupiter, RECO Health’s Delray Beach campus sits 32 miles south on I-95, a drive that runs about 45 minutes outside the morning and evening rush windows. For residents of Abacoa, Jupiter Inlet Colony, Tequesta, Admirals Cove, and Jonathan’s Landing, that distance is the deliberate feature of the arrangement — close enough to sustain a Monday-through-Friday Transcranial Magnetic Stimulation Therapy protocol without relocating, far enough that the clinical work happens outside the neighborhoods and social patterns where the depression has taken root.

Who is a candidate for rTMS

The insurance-covered indication for repetitive Transcranial Magnetic Stimulation is major depressive disorder with documented failure of at least two adequate antidepressant trials. “Adequate” is the operative word — payers require documentation that each trial met minimum therapeutic dose, minimum duration of six to eight weeks, and reasonable adherence. A patient who tried sertraline for three weeks at 25 mg and stopped because of nausea has not, by insurer definition, completed an adequate trial. RECO Health’s psychiatry team reconstructs the pharmacologic history in the initial evaluation, including SSRIs, SNRIs, atypicals like bupropion and mirtazapine, and augmentation strategies with lithium, aripiprazole, or quetiapine.

Clinical candidacy runs alongside the insurance criteria. Screening rules out implanted metallic devices within 30 centimeters of the coil, cochlear implants, deep brain stimulators, and cardiac pacemakers. Personal or family history of seizure disorder is a relative contraindication that requires case-by-case review. Active, unstable substance use is generally deferred until the client is stabilized — often through RECO’s outpatient or PHP tracks first — because untreated stimulant or alcohol use disorder confounds both the seizure risk and the depression response.

On the deep TMS platform, RECO also treats obsessive-compulsive disorder, with candidacy scored using the Yale-Brown Obsessive Compulsive Scale (YBOCS) and confirmed against a documented failure of at least one SSRI trial at OCD-range dosing.

The 36-session protocol and what it actually looks like

Session one is motor threshold mapping. The technician positions the coil over the motor cortex and delivers single pulses at gradually increasing intensity until the minimum output that reliably produces a visible thumb twitch is identified. Treatment intensity is then set at 120% of that motor threshold — a personalized dose that accounts for individual differences in skull thickness and cortical anatomy. The coil is then repositioned over the left dorsolateral prefrontal cortex, and the treatment protocol delivers 3,000 pulses at 10 Hz over roughly 20 to 40 minutes depending on the manufacturer’s protocol.

Sessions two through thirty run daily, Monday through Friday, for six consecutive weeks. Clients sit upright in a treatment chair, remain awake and conversant, and can read, watch something on a phone, or listen to music. The most common side effect is mild scalp discomfort at the stimulation site during the first several sessions, which typically attenuates as the scalp musculature adapts. There is no sedation, no cognitive fog, and no post-session recovery window — clients drive themselves home and return to work the same day.

The final six sessions are a structured taper: three sessions the first week, two the second, one the third. The taper is not decorative. It consolidates the response and is associated with lower relapse rates than an abrupt end at session thirty.

Response, remission, and the second-course question

Published response rates for rTMS in treatment-resistant depression run 40-60%, and remission rates run 25-40%, with variation by protocol, definition of response, and severity of the treated cohort. Response is defined as a 50% reduction from baseline PHQ-9 or Hamilton Depression Rating Scale score; remission is defined as PHQ-9 below 5 or HAM-D below 7. Clinically meaningful improvement typically emerges between sessions 15 and 25, with continued gains through the taper — which is why an early non-response is not, on its own, grounds for discontinuation.

Clients who show minimal change by session 20 to 25 are re-evaluated by the RECO psychiatry team. Options include repositioning the coil using a neuronavigation adjustment, switching from standard 10 Hz stimulation to an intermittent theta burst protocol, augmenting with a medication change, or — for a subset of cases where the underlying phenotype is more consistent with anhedonic or suicidal depression — transitioning to the intravenous ketamine or intranasal esketamine pathway that RECO also runs in-house.

Responders who later relapse are candidates for a second full course, typically 12 to 18 months after the first. Insurance coverage for a repeat course is generally available when documentation demonstrates initial response followed by return of symptoms.

iTBS and the shorter-session option

Intermittent Theta Burst Stimulation is an FDA-cleared alternative protocol that compresses a full rTMS treatment into approximately three minutes of stimulation. Delivered as short bursts of high-frequency pulses in a patterned sequence, iTBS produces the same excitatory effect on the left DLPFC as standard 10 Hz rTMS and has demonstrated non-inferior efficacy in the THREE-D trial and subsequent replications.

For clients driving in from Jupiter, the practical implication is significant. A three-minute session with intake and setup fits inside a 20-minute total campus visit, which changes the calculus of a 90-minute round-trip drive over six weeks. Not every commercial plan reimburses iTBS at the same rate as standard rTMS; RECO’s admissions team verifies the specific benefit before enrolling and, when iTBS is not covered, presents the standard protocol as the alternative.

What the first visit at RECO looks like

The initial appointment is a psychiatric evaluation, not a TMS session. A board-certified psychiatrist conducts a full diagnostic interview, administers standardized scales (PHQ-9, GAD-7, and where relevant the ASRS or YBOCS), reviews the pharmacologic history in detail, and screens for the contraindications above. The evaluation typically runs 60 to 90 minutes.

If TMS is indicated, the prior authorization packet is assembled and submitted within one to three business days. Once authorization is received, motor threshold mapping is scheduled. Concurrent psychotherapy — CBT, ACT, or behavioral activation, delivered by RECO’s outpatient clinical team — is encouraged alongside the TMS course, as combined treatment is associated with more durable remission than either modality alone.

Insurance and admissions from Jupiter

RECO Health is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans. The admissions team verifies benefits, confirms the two-antidepressant-trial documentation, and quotes out-of-pocket exposure — typically a specialist copay per session or a percentage after deductible, depending on the plan.

For families in Tequesta or Jonathan’s Landing weighing whether a daily drive is sustainable, the six-week structure is worth mapping onto an actual calendar before enrollment. iTBS shortens the chair time; iTBS candidacy is confirmed at the psychiatric evaluation.

Serving residents of: Abacoa, Jupiter Inlet Colony, Tequesta, Admirals Cove, Jonathan's Landing.