Biologic Blood Testing (Full Panel)

Our standard psychiatric admission panel is broad on purpose. At RECO Immersive in Delray Beach we draw a complete blood count (CBC) for anemia and infection, a comprehensive metabolic panel (CMP) for kidney, liver, glucose, and electrolyte status, a full thyroid panel (TSH, free T3, free T4, and reflex thyroid antibodies when indicated), serum vitamin B12 and folate, 25-hydroxy vitamin D, ferritin and iron studies, methylation markers including homocysteine, inflammatory markers such as high-sensitivity CRP, and a hormone panel covering testosterone, estradiol, DHEA, and cortisol when symptoms warrant. For some patients we add lipid panel, hemoglobin A1c, magnesium, zinc, and copper. The intent is to surface every medical contributor to mood, sleep, energy, and cognition before we finalize a psychiatric medication plan.

Because thyroid disease is one of the most common medical impostors of psychiatric illness. Hypothyroidism mimics major depression almost perfectly — fatigue, low motivation, weight gain, slowed thinking, anhedonia, low mood — and it will not respond to antidepressants until the thyroid is corrected. Hyperthyroidism, conversely, mimics generalized anxiety, panic disorder, and even mania, with racing heart, tremor, insomnia, irritability, and sweating. At RECO Immersive we measure TSH, free T3, and free T4 on every patient, not just TSH alone, because TSH can sit in the normal range while peripheral conversion to active T3 is impaired. We add thyroid antibodies (TPO and thyroglobulin) when there is a personal or family history of autoimmune thyroid disease, since Hashimoto’s thyroiditis often presents psychiatrically before lab values shift.

Specific deficiencies produce specific psychiatric phenotypes. Vitamin B12 deficiency causes depression, cognitive fog, and in advanced cases frank psychosis or dementia — particularly in older adults, vegetarians, and patients on long-term proton pump inhibitors or metformin. Folate deficiency, which often coexists with B12 deficiency, blunts response to nearly every antidepressant. Vitamin D deficiency is strongly associated with seasonal affective disorder (SAD) and with worse outcomes in major depressive disorder; correction frequently improves mood within weeks. Iron deficiency — even without anemia — causes the fatigue, brain fog, restless legs, and PMDD-pattern irritability that many women come to RECO Immersive describing. Identifying and correcting these deficiencies on day one means the psychiatric medications we prescribe are working with a body that has the raw materials to actually respond.

The neuroinflammation literature points to three markers worth tracking. High-sensitivity C-reactive protein (hs-CRP) above roughly 3 mg/L predicts poorer response to standard antidepressants and better response to anti-inflammatory augmentation strategies. Interleukin-6 (IL-6) is elevated in a meaningful subset of patients with treatment-resistant depression and in bipolar depression; it correlates with cognitive symptoms and fatigue more than with classic sad mood. Homocysteine, a methylation marker, runs high in patients with MTHFR variants and B-vitamin deficiency and is associated with both depression and cardiovascular risk. At RECO Immersive in Delray Beach we measure these alongside the standard panel because they identify patients whose depression has a clear inflammatory or methylation driver — a finding that meaningfully changes which interventions we choose.

Yes, in nearly all cases. Standard psychiatric admission bloodwork — CBC, CMP, thyroid panel, B12, folate, vitamin D — is covered by all major insurance carriers when ordered with a documented medical-necessity rationale through a psychiatric or primary care provider, which RECO Immersive supplies. Coverage for hormones, advanced inflammatory markers, and methylation testing is more variable; some carriers cover them when there is documentation of treatment-resistant symptoms, while others classify them as elective. Our admissions team in Delray Beach verifies benefits before any blood is drawn, flags any test that may incur out-of-pocket cost, and walks you through alternatives. We also work with patients who pay cash to use direct-to-lab pricing, which can be substantially lower than insurance-billed rates for the same panel.

Baseline bloodwork happens at admission, and we repeat targeted panels at clinically appropriate intervals depending on what you are taking. For patients on lithium we check serum lithium levels, kidney function, and TSH every three months, then every six months once stable. For patients on second-generation antipsychotics we monitor fasting glucose, hemoglobin A1c, and lipid panel every three to six months because of metabolic risk. For patients on lamotrigine, valproate, or carbamazepine we follow drug-specific markers including liver function and CBC. Patients on stimulants get periodic blood pressure and cardiac review rather than blood draws. Independent of medication, RECO Immersive rechecks vitamin D, B12, ferritin, and thyroid every six months while a patient is in active treatment, so corrections actually take hold and so we catch any new medical contributor early.