TMS therapy for Palm Beach Gardens — FDA-cleared TRD care, 35 minutes from home.

For a Palm Beach Gardens resident — PGA National, Mirasol, BallenIsles, Frenchman's Reserve — RECO Health puts a fully staffed neuromodulation program 35 minutes down I-95 rather than fragmented across three referrals in northern Palm Beach County. The psychiatry team runs FDA-cleared rTMS and deep TMS on the 36-session protocol at 120% of motor threshold, layered onto medication management and, where indicated, ketamine or Spravato in the same building. No handoffs, no records chase between clinics, and prior authorization handled in-house.

Palm Beach Gardens sits 25 miles north of RECO Health’s Delray Beach campus — roughly 35 minutes down I-95 outside of season traffic. For residents of PGA National, BallenIsles, Mirasol, Frenchman’s Reserve, and Old Palm, that corridor collapses what is otherwise a fragmented referral chain in northern Palm Beach County into a single clinical address: psychiatry, neuromodulation, and, where relevant, ketamine and intensive outpatient care under one roof. Our TMS therapy program treats treatment-resistant major depressive disorder and OCD using FDA-cleared repetitive and deep TMS protocols, delivered by a psychiatry team that also owns the medication regimen alongside the coil.

Who is a candidate for rTMS

The insurance-covered indication is major depressive disorder that has not responded to at least two adequate antidepressant trials. “Adequate” is defined narrowly by payers: a target dose held for at least six weeks with documented adherence. A two-week course of sertraline that ended when the client stopped taking it does not count. The intake psychiatrist reconstructs the pharmacotherapy history in detail — SSRI, SNRI, atypical antidepressant, augmentation with aripiprazole, lithium, quetiapine, buspirone, or olanzapine — because the prior authorization packet lives or dies on that documentation.

Clinical candidacy extends past payer criteria. Screening rules out implanted metallic devices near the head — cochlear implants, aneurysm clips, deep brain stimulators — along with personal or first-degree family history of seizures, active substance use that raises seizure threshold concerns, and pregnancy in the case of deep TMS. Bipolar disorder is ruled out with a Mood Disorder Questionnaire and clinical interview, since unipolar TRD is the labeled indication and induction of hypomania is a real if uncommon adverse event.

Baseline severity is captured with the PHQ-9 and GAD-7, and the YBOCS is added for candidates on the deep TMS OCD protocol. Both scales are repeated weekly through treatment so response is tracked objectively rather than by clinical impression alone.

The 36-session protocol and what it actually looks like

Session one is motor threshold mapping. A single-pulse coil is positioned over primary motor cortex and intensity is titrated until a reliable thumb twitch is evoked; treatment is then delivered at 120% of that motor threshold, targeted five centimeters anterior to the motor hotspot over the left dorsolateral prefrontal cortex. Standard rTMS delivers 3,000 pulses per session at 10 Hz in a train-and-rest pattern, running 20 to 40 minutes in the chair.

Sessions two through thirty run daily Monday through Friday for six weeks. Clients sit upright, awake, reading or listening to music, and drive themselves home. There is no sedation, no cognitive impairment, no post-procedure recovery. The most common adverse effects are scalp discomfort at the coil site and mild tension-type headache in the first week, both of which typically resolve as the scalp accommodates to the pulse. Seizure risk on standard protocols is on the order of 1 in 30,000 sessions.

The final six sessions are a taper — three per week for two weeks, then two, then one — designed to consolidate response and reduce early relapse. Clients continue any concurrent antidepressant or mood stabilizer throughout; TMS is additive to pharmacotherapy rather than a substitute for it.

Response, remission, and the second-course question

Published response rates for rTMS in treatment-resistant depression run 40 to 60 percent depending on protocol, coil design, and how response is defined. Remission rates — PHQ-9 under 5 or Hamilton under 7 — sit in the 25 to 40 percent range. Response typically emerges between sessions 15 and 25 and continues to deepen through the taper, which is one reason the full 36-session course matters even when the client feels substantially improved at session 20.

Non-responders at sessions 20 to 25 are re-evaluated in case conference. Sometimes the coil position warrants a neuronavigated re-mapping. Sometimes the case moves to intermittent theta burst, which recruits a partially different pulse pattern. Sometimes the clinical picture — anhedonia dominant, active suicidal ideation, prior ketamine responsiveness — points to the racemic ketamine or esketamine (Spravato) pathway, and the psychiatry team makes that handoff internally rather than referring out.

Responders who later relapse are candidates for a second full course, typically 12 to 18 months after the first. Some clients transition to a maintenance schedule of one to two sessions per month depending on relapse history and payer authorization.

iTBS and the shorter-session option

Intermittent Theta Burst Stimulation is an FDA-cleared alternative rTMS protocol that compresses the treatment session from 20-40 minutes to roughly three minutes without loss of efficacy. The THREE-D trial demonstrated non-inferiority to standard 10 Hz rTMS in TRD, and iTBS has become the default at many academic programs on throughput alone.

For a PGA National or Mirasol client whose workday cannot absorb a 45-minute treatment window plus commute, iTBS makes daily treatment operationally feasible. The pulse pattern is different — three-pulse bursts at 50 Hz, repeated at 5 Hz — but the target (left DLPFC), the intensity (120% MT), and the six-week daily cadence remain the same. Coverage varies by plan; some payers reimburse iTBS at parity with standard rTMS, others require a separate authorization, and the intake team confirms this before the mapping session so no one is surprised at session five.

What to expect on the first visit

The first appointment is a psychiatric evaluation, not a treatment session. A RECO psychiatrist reconstructs the depression history in detail — episode count, duration, prior response, current pharmacotherapy — administers the PHQ-9, GAD-7, and where clinically indicated the MDQ and ASRS, and reviews any prior neuroimaging or EEG. If TMS candidacy is confirmed, the prior authorization is filed the same week and mapping is typically scheduled within seven to ten days.

Concurrent care coordination begins at this visit. If a client is already engaged with an outside psychiatrist or therapist and intends to keep that relationship, RECO coordinates rather than duplicating. If additional structure is warranted — intensive outpatient programming, medication-assisted treatment with buprenorphine or naltrexone for co-occurring substance use, individual CBT or DBT, EMDR for trauma driving the depressive picture, or ACT and motivational interviewing where indicated — that is layered in with the client’s written consent.

Insurance and admissions from Palm Beach Gardens

RECO Health is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans that include mental-health neuromodulation coverage. Prior authorization for rTMS is standard once the two-antidepressant-trial threshold is documented, and the admissions team assembles the packet — pulling records from prior prescribers when needed — rather than pushing that work back to the client.

For a Palm Beach Gardens resident, the practical logistics are 35 minutes down I-95 to Delray Beach, Monday through Friday, for six weeks, followed by a three-week taper. Most clients continue working through treatment. Early-morning and late-afternoon session windows are protected for out-of-town clients so the daily commute stays outside peak I-95 congestion, and the admissions team walks through copay, coinsurance, and deductible position before the first visit rather than after.

Serving residents of: BallenIsles, Frenchman's Reserve, Mirasol, Old Palm, PGA National.