TMS therapy for Lantana — FDA-cleared TRD care, 18 minutes from home.

RECO Health's Delray Beach psychiatry clinic sits 18 minutes down Federal Highway from Old Town Lantana and Hypoluxo Island. rTMS is delivered by a board-certified psychiatrist on the FDA-cleared 36-session protocol — 10 Hz stimulation at 120% of motor threshold over the left DLPFC — with medication management, prior authorization, and any concurrent ketamine or Spravato pathway coordinated on the same campus. The full continuum from outpatient psychiatry through IOP and PHP means the case does not have to travel between clinics if the treatment plan shifts mid-course.

Lantana and Hypoluxo Island occupy a narrow strip of barrier coast between Delray Beach and West Palm Beach, roughly 18 minutes south of Old Town Lantana via Federal Highway or A1A. For residents of Manalapan and Ocean Ridge who have cycled through two or more antidepressants without meaningful remission, RECO Health’s psychiatry department in Delray Beach offers repetitive transcranial magnetic stimulation on the FDA-cleared 36-session protocol for treatment-resistant depression and deep TMS for obsessive-compulsive disorder. TMS therapy at RECO is delivered by a board-certified psychiatrist alongside the site’s outpatient psychiatric services, so medication management and any concurrent therapy stay coordinated on the same campus.

Who is a candidate for rTMS

The insurance-covered indication for rTMS is major depressive disorder that has failed to remit after at least two adequate antidepressant trials. “Adequate” is a technical standard: the medication was prescribed at a therapeutic dose (for example, sertraline 150-200 mg, venlafaxine 225 mg, escitalopram 20 mg), taken for six to eight weeks with documented adherence, and either produced no meaningful reduction on the PHQ-9 or triggered intolerable side effects. Augmentation trials with aripiprazole, lithium, or quetiapine that failed to move the PHQ-9 below the moderate range also count toward the two-trial threshold under most payer policies.

Clinical candidacy runs alongside insurance criteria. RECO’s psychiatry team screens each intake for:

• Cardiac pacemakers, cochlear implants, aneurysm clips, or other ferromagnetic hardware in the head or neck
• Personal or family history of seizure, or current medications that lower cortical seizure threshold
• Active mania, untreated psychosis, or psychotic-spectrum depression that would alter the treatment pathway
• Untreated substance use disorder that would confound weekly PHQ-9 tracking

For deep TMS on the OCD indication, candidacy also requires YBOCS documentation of moderate-to-severe symptom burden and an adequate SSRI trial at high dose — typically fluoxetine 60-80 mg or sertraline 200 mg — with or without an aripiprazole augmentation trial.

The 36-session protocol and what treatment actually looks like

Session one is motor threshold mapping. The treating clinician delivers single pulses over the left primary motor cortex to identify the minimum intensity that reliably evokes a visible twitch of the contralateral abductor pollicis brevis in at least five of ten pulses. That value becomes the resting motor threshold, and stimulation intensity for the full course is set at 120% of motor threshold. The coil is then repositioned to the left dorsolateral prefrontal cortex using either the standard 5.5 cm rule or an F3 EEG-based localization.

Sessions two through thirty run Monday through Friday for six consecutive weeks. The standard 10 Hz protocol delivers 3000 pulses per session in four-second trains separated by 26-second inter-train intervals, occupying roughly 37 minutes in the treatment chair. The final six sessions form a taper — three the first week, two the next, one the last — during which the psychiatry team tracks PHQ-9 or MADRS scores weekly. Clients drive themselves to and from each appointment, return to work the same day, and typically report mild scalp discomfort or a transient tension headache that resolves within the first week.

Response, remission, and the question of a second course

Published response rates for rTMS in treatment-resistant depression run 40-60%, defined as a 50% or greater reduction in MADRS or PHQ-9 score from baseline. Remission rates — PHQ-9 below 5 or MADRS below 10 — sit between 25% and 40% depending on study population and protocol. Response typically emerges between sessions 15 and 25, though a subset of clients does not begin to shift until the taper. RECO’s psychiatry team tracks scores at each visit and does not declare a non-response until at least session 25 has been delivered on protocol.

For clients who plateau by session 20 to 25 without movement, the treating psychiatrist has three options: re-map the coil position and adjust the treatment target, switch the protocol from standard 10 Hz to intermittent theta burst stimulation, or transition the case onto the ketamine or esketamine (Spravato) pathway that RECO operates on the same campus. Clients who respond and later relapse are candidates for a full second course, typically 12 to 18 months after the initial series, and some carry a monthly maintenance schedule between courses to hold the gains.

iTBS and the shorter-session option

Intermittent theta burst stimulation is an FDA-cleared alternative rTMS protocol that compresses the treatment session from roughly 37 minutes to three. iTBS delivers 600 pulses per session — bursts of three pulses at 50 Hz repeated every 200 milliseconds for two seconds, followed by an eight-second rest, cycled across 20 trains. Stimulation intensity remains at 120% of motor threshold and the target remains the left DLPFC. The THREE-D trial (Blumberger et al., 2018) established non-inferiority to the standard 10 Hz protocol on both response and remission endpoints.

For clients whose workday cannot accommodate a 45-minute treatment window plus travel from Lantana, iTBS makes daily therapy realistic without diluting the evidence base. RECO’s psychiatry team confirms coverage for iTBS specifically before enrollment — not every commercial plan reimburses the two protocols at parity, and a small number still require standard 10 Hz as first-line before authorizing iTBS.

Concurrent medication and psychotherapy during the course

Existing antidepressants and mood stabilizers are generally maintained through the TMS course. Sertraline, escitalopram, bupropion, venlafaxine, lamotrigine, and lithium at established doses continue unchanged when they have provided partial benefit or address comorbid anxiety measured on the GAD-7. Medications known to attenuate cortical response — benzodiazepines in particular, and any agent that meaningfully lowers seizure threshold — are discussed individually, and the psychiatry team will coordinate a taper with the outside prescriber before mapping when clinically indicated.

Psychotherapy is encouraged concurrently. CBT, behavioral activation, ACT, and DBT for clients with prominent affective instability all potentiate response and reduce relapse after the course completes. RECO offers integrated therapy on the same campus for clients who do not have an outside therapist, and the psychiatry team exchanges routine progress notes with community providers for clients who prefer to keep their existing therapeutic relationship intact.

Insurance and admissions from Lantana

RECO Health accepts Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans for TMS. All commercial payers require documented treatment resistance — the two-trial rule — before approving the 36 sessions, and RECO’s admissions team assembles the documentation packet and submits prior authorization directly on the day of the initial psychiatric evaluation. Turnaround typically runs three to five business days. Self-pay pricing is available for clients without qualifying coverage or those who prefer to bypass prior authorization for privacy reasons.

The drive from Old Town Lantana runs 18 minutes on Federal Highway (US-1), or a coastal route via A1A through Manalapan and Gulf Stream that is often lighter in traffic during season. Off-season, the treatment window fits comfortably inside a lunch hour for clients working in Lantana or on the barrier island. Admissions can be reached seven days a week for candidacy screening and prior-authorization intake.

Serving residents of: Hypoluxo Island, Manalapan, Ocean Ridge, Old Town Lantana.