TMS therapy for Wellington — FDA-cleared TRD care, 38 minutes from home.

Wellington clients seeking TMS drive 28 miles east to RECO Health's Delray Beach psychiatry service — roughly 38 minutes from Olympia, Palm Beach Polo, or Aero Club. RECO delivers the full FDA-cleared 36-session rTMS protocol at 120% motor threshold, offers intermittent theta burst for clients who cannot sit through a 37-minute session, and pairs TMS with in-house medication management, ketamine, and the broader continuum when clinical picture warrants it. Verification of benefits and prior authorization are handled in-house before the first treatment day.

Wellington sits 28 miles west of RECO Health’s Delray Beach campus — roughly 38 minutes by car via Southern Boulevard and the Florida Turnpike. For clients in Olympia, Versailles, Aero Club, Palm Beach Polo, and Wellington View, daily cross-county TMS sessions are a real logistical commitment, and most patients handle it either through the shorter intermittent theta burst protocol or a short stay in RECO’s sober-living network during the acute six-week block. This page explains what Transcranial Magnetic Stimulation looks like on the RECO psychiatry service and how Wellington residents typically enter it.

Who is a candidate for rTMS

The insurance-covered indication is major depressive disorder with documented failure of at least two adequate antidepressant trials — adequate meaning correct dose, at least six weeks of duration, and confirmed adherence. Common documentation includes an SSRI trial (sertraline, escitalopram, fluoxetine) plus a second-line agent (bupropion, venlafaxine, duloxetine) or augmentation with aripiprazole, quetiapine, or lithium. A current PHQ-9 at or above 15 typically anchors the medical-necessity narrative for prior authorization.

Beyond the depression indication, deep TMS on the H-coil platform is FDA-cleared for OCD in patients with YBOCS scores above 20 who have failed two adequate SSRI trials at maximum tolerated dose. Contraindications RECO’s psychiatry team screens for include implanted metallic hardware within 30 cm of the coil (cochlear implants, deep-brain stimulators, aneurysm clips, some stents), history of seizure disorder, active substance use that would compromise the daily schedule, and pregnancy on certain protocols. Unstable bipolar disorder without a mood stabilizer on board is a relative contraindication — initial workup typically includes MDQ screening.

The intake sequence for a Wellington referral runs in order: psychiatric evaluation, treatment-history documentation, motor threshold mapping, prior authorization, then a scheduled six-week treatment block.

The 36-session protocol and what it actually looks like

Session one is motor threshold mapping. The technician places the figure-eight coil over the motor cortex, delivers single pulses at ascending intensities, and identifies the minimum output that reliably evokes a visible thumb twitch in five of ten trials. Treatment intensity is then set at 120% of that motor threshold — the FDA-cleared parameter for standard rTMS.

Sessions two through thirty are daily, Monday through Friday, across six weeks. Standard 10 Hz rTMS at the left dorsolateral prefrontal cortex delivers 3,000 pulses per session over roughly 19 to 37 minutes depending on the specific protocol. Clients sit upright, wear earplugs, and typically read or watch something on a tablet. The most common side effect is scalp discomfort at the stimulation site during the first week — usually manageable with acetaminophen and coil-position adjustment. Seizure risk on standard parameters is approximately 1 in 30,000 sessions.

The final six sessions are a taper: three in week seven, two in week eight, one in week nine. Clients drive themselves home from every session, return to work or school the same day, and require no anesthesia, sedation, or companion driver — the operational difference from ECT that most patients ask about first.

Response, remission, and the second-course question

Published response rates for rTMS in treatment-resistant depression run 40-60% depending on protocol and how response is defined — typically a 50% reduction in PHQ-9 or HAM-D from baseline. Remission rates, meaning PHQ-9 under 5 or HAM-D under 7, run 25-40%. Response emerges between sessions 15 and 25, with continued gains through the taper. It is not a session-one intervention; patients expecting acute mood lift in the first week are counseled otherwise at intake.

Non-responders at the session 20-25 checkpoint are re-evaluated by the treating psychiatrist. Common adjustments include coil-position revision (moving from the 5.5 cm rule to Beam F3 targeting), a switch to intermittent theta burst, addition of a low-dose augmentation agent, or transition to the ketamine or esketamine pathway — RECO’s psychiatry team runs both service lines, so the handoff is internal rather than an external referral.

Responders who later relapse — the natural history of TRD is a relapsing course — are candidates for a second full course, typically 12 to 18 months after the index treatment. Insurance reauthorization is straightforward when the first course produced documented remission followed by documented relapse on standard depression rating scales.

iTBS and the shorter-session option

Intermittent Theta Burst Stimulation is an FDA-cleared alternative rTMS protocol that delivers equivalent efficacy — the THREE-D trial demonstrated non-inferiority to standard 10 Hz rTMS — in a three-minute session rather than a 19 to 37 minute session. The stimulation pattern is bursts of three pulses at 50 Hz, repeated at 5 Hz for two seconds on and eight seconds off, over 600 pulses.

For a Wellington client driving 38 minutes each way, the difference between a three-minute treatment and a 37-minute treatment is meaningful. Chair time collapses to under 10 minutes including setup, and the total daily commitment — including drive — sits closer to 90 minutes than to two and a half hours. Not every commercial plan reimburses iTBS at the same rate as standard rTMS, and prior authorization criteria occasionally differ; the psychiatry team confirms coverage before enrolling.

What to expect on your first visit

The first appointment is a psychiatric evaluation, not a treatment session. Expect 60 to 90 minutes with the treating physician covering current symptoms, PHQ-9 and GAD-7 administration, complete antidepressant trial history (agent, dose, duration, response, adherence), medical history including any implanted metal near the head, substance use screening via AUDIT-C and DAST-10, and safety assessment. If medical detox or acute stabilization is indicated first — CIWA or COWS monitoring, buprenorphine or naltrexone induction — that pathway is coordinated on the same visit.

Motor threshold mapping is scheduled as a separate 45-minute appointment once prior authorization clears, usually two to three weeks after intake given commercial-payer turnaround. Referring clinicians in Wellington can send records ahead through the TMS therapy program intake line. Wellington clients staying in a RECO sober-living residence during the acute block transition to daily transportation from the residence rather than commuting from home.

Insurance and admissions from Wellington

Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans all cover rTMS for the TRD indication under standard medical-necessity criteria: two documented failed antidepressant trials, a current major depressive episode, and no contraindications. Prior authorization typically clears in seven to fourteen business days once the psychiatric evaluation and treatment-history documentation reach the payer.

Out-of-pocket cost varies by plan. Per-session copays are common on commercial plans, and the January deductible reset drives many patients to schedule the six-week block early in the calendar year. For Wellington clients whose treatment plan pairs TMS with a residential, PHP, or IOP level of care under ASAM Criteria dimensions, insurance authorization runs as a single coordinated case rather than two parallel authorizations.

Serving residents of: Olympia, Versailles, Aero Club, Palm Beach Polo, Wellington View.