TMS therapy for Miami — FDA-cleared TRD care, 65 minutes from home.

For Miami clients from Brickell to Aventura, RECO Health's Delray Beach campus is a 65-minute drive up I-95, with in-house psychiatry running the full FDA-cleared rTMS protocol: motor threshold mapping, 3,000 pulses at 10 Hz over the left DLPFC at 120% of motor threshold, and Beam F3 coil positioning. Prior authorization is handled in-house against two documented antidepressant trials, and where the six-week daily cadence conflicts with a Miami commute we offer on-site sober living or the three-minute iTBS alternative. Deep TMS for OCD is available on the same campus with Y-BOCS-guided authorization.

For clients in Brickell, Coral Gables, or Coconut Grove, the drive up I-95 to RECO Health’s Delray Beach campus runs about 65 minutes — far enough from Miami’s social triggers to matter clinically, close enough that family can drive up on weekends. The psychiatry team delivers repetitive Transcranial Magnetic Stimulation Therapy for treatment-resistant depression and deep TMS for OCD under FDA-cleared protocols, with treatment-history review, prior authorization, and coil mapping handled in-house before session one.

Who is a candidate for rTMS

The standard insurance-covered indication is major depressive disorder with documented failure of at least two adequate antidepressant trials. Adequacy has a specific meaning: therapeutic dose reached, minimum six to eight weeks at that dose, and confirmed adherence. A patient who stopped sertraline at 50 mg after three weeks because of GI side effects has not completed an adequate trial. The intake psychiatrist reviews the full pharmacologic history — SSRIs, SNRIs, atypical augmentation with aripiprazole or quetiapine, mood stabilizers such as lithium if bipolar spectrum is on the differential — and documents each attempt in the language payers require.

Contraindications are absolute or relative. Implanted ferromagnetic hardware within 30 cm of the coil (cochlear implants, aneurysm clips, deep brain stimulators, VNS) is disqualifying. Personal or family history of seizure raises the threshold; active alcohol withdrawal, bupropion at high dose, and tramadol on board are all reviewed before proceeding. Bipolar depression is not a contraindication but requires mood-stabilizer coverage to reduce switch risk. Screening scales at intake include the PHQ-9 for depression severity, GAD-7 for comorbid anxiety, the MDQ to rule out unrecognized bipolarity, and Y-BOCS when OCD is the target diagnosis for deep TMS.

The 36-session protocol and what it actually looks like

Session one is motor threshold mapping. The technician determines the minimum stimulator output that reliably produces a visible twitch in the abductor pollicis brevis — usually five out of ten pulses. Treatment intensity is then set at 120% of that resting motor threshold. The coil is repositioned to the F3 location over the left dorsolateral prefrontal cortex, typically using the Beam F3 method or a neuronavigation system when available.

Sessions two through thirty are daily Monday through Friday. A standard high-frequency protocol delivers 3,000 pulses per session at 10 Hz — four-second trains, 26-second inter-train intervals, roughly 37 minutes in the chair. The final six sessions are a taper: three per week, then two, then one. Clients drive themselves home, return to work the same day, and typically report mild scalp discomfort or a dull headache in the first week that resolves with over-the-counter analgesics. Seizure risk on protocol is under 0.1% per course.

Response, remission, and the second-course question

Published response rates for rTMS in treatment-resistant depression run 40 to 60% depending on how response is defined and which protocol is used; remission rates fall between 25 and 40%. Response is generally defined as a 50% reduction in PHQ-9 or MADRS from baseline; remission requires a PHQ-9 under 5 or MADRS under 10. Response typically emerges between sessions 15 and 25, with continued gains through the taper phase.

Non-responders at session 20 to 25 trigger a case review. Sometimes the coil position warrants adjustment — the Beam F3 target can sit a centimeter off the individually optimal site in patients with atypical skull geometry. Sometimes the protocol should switch to intermittent theta burst or to a right-sided low-frequency 1 Hz protocol targeting the right DLPFC. In some cases the file belongs on the ketamine or esketamine pathway rather than a continued TMS course. Responders who later relapse — typically at 6 to 12 months out — are candidates for a second full 36-session course; a maintenance schedule of one to two sessions weekly is an alternative when the relapse pattern is predictable.

iTBS and the shorter-session option

Intermittent Theta Burst Stimulation is an FDA-cleared alternative that delivers 600 pulses in a three-minute session — bursts of three pulses at 50 Hz, repeated at 5 Hz, in a two-second-on, eight-second-off pattern. Head-to-head trials, including THREE-D, demonstrate non-inferiority to standard 10 Hz rTMS for major depression.

For working clients in Brickell or Aventura who cannot commit to a 40-minute treatment window plus the round trip to Delray, iTBS makes the daily cadence structurally feasible. Not every commercial plan reimburses iTBS at parity with high-frequency rTMS; the psychiatry team confirms coverage before enrollment, and where iTBS is not authorized the standard 10 Hz protocol runs as the default.

What to expect on your first visit

The initial appointment is a 60- to 90-minute psychiatric evaluation. The evaluating psychiatrist takes the full history, administers PHQ-9 and GAD-7, screens for bipolarity and substance use with the MDQ and AUDIT, reviews imaging or EEG if seizure history is on record, and documents each prior antidepressant trial in the format payers require for prior authorization. If concurrent addiction treatment is on the table, the ASAM Criteria assessment across the six dimensions is folded into the same visit.

Motor threshold mapping is generally scheduled on a separate day once prior authorization has cleared. Miami clients who are pairing TMS with residential or PHP-level addiction treatment complete admissions through a single intake team and step into TMS on the standard protocol schedule; those coming for TMS alone are scheduled around their work calendar and, where clinically appropriate, offered on-site sober living during the six-week intensive phase.

Insurance and admissions from Miami

RECO Health is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and most BCBS plans. Prior authorization for rTMS is standard once two adequate antidepressant trials are documented; the admissions team runs the benefits check and files the authorization request before scheduling mapping. Out-of-pocket exposure is confirmed in writing before treatment begins, and where a plan requires an appeal on a specific trial gap the psychiatry team drafts the letter.

Most Miami-based clients drive up I-95 for the initial evaluation and then decide between a daily commute and short-term local housing during the intensive weeks. For clients also stabilizing early recovery from alcohol or opioid use disorder, the on-campus continuum — from medical detox with CIWA- or COWS-guided protocols through PHP and IOP with buprenorphine or naltrexone maintenance — runs alongside TMS on the same weekly schedule.

Serving residents of: Brickell, Coral Gables, Coconut Grove, Aventura, Pinecrest.