Uncovering Modifiable Contributors to Depressive Symptoms During Antidepressant Prescription Renewal: A Primary Care...

Depressive symptoms in primary care often arise from a complex interplay of hormonal, biological, metabolic, psychosocial, and lifestyle factors. We present the case of a 41-year-old woman whose depressive symptoms began three months postpartum after her second pregnancy and persisted for approximately five years. In June 2025, she presented requesting escitalopram renewal following a brief treatment interruption. She preferred management within primary care and declined referral for psychiatric treatment. Comprehensive reassessment identified severe iron and vitamin B12 deficiency, as well as metabolic alterations in the setting of long-standing postpartum depression. Management included correction of micronutrient deficiencies, structured weight management, and patient-led lifestyle interventions, alongside continued antidepressant therapy. Over the following months, depressive symptoms improved substantially alongside improvement in ferritin and vitamin B12 levels and metabolic improvements. This case illustrates how systematic, longitudinal primary care can identify potentially modifiable somatic factors in patients with persistent depressive symptoms and may support clinical improvement.