Outcomes of high-compliance bracing in patients with severe adolescent idiopathic scoliosis declining operative intervention.

Depressive symptoms are among the most prevalent presentations in primary care and are frequently managed pharmacologically [, ]. Increasing evidence supports a broader understanding of depression as influenced by hormonal, biological, metabolic, psychosocial, and lifestyle‐related factors [, ]. The postpartum period represents a time of vulnerability, characterized by hormonal fluctuations, sleep disruption, psychosocial stressors, and increased nutritional demands [, , ]. Micronutrient deficiencies, particularly iron and vitamin B12, have been associated with fatigue, cognitive impairment, and mood disturbances, and may be linked to depressive symptoms during the perinatal and postpartum periods [, , , , ]. Persistent postpartum depression may further affect lifestyle habits and metabolic health, potentially contributing to clinical symptom burden [, , , , , , ]. While many cases remit within the first year, a subset experiences prolonged symptoms [, , , , , , ]. Here, we describe a patient whose postpartum‐onset depressive symptoms persisted for five years and were managed within primary care. A subsequent reassessment during antidepressant prescription renewal identified several potentially modifiable factors. A 41‐year‐old woman presented in June 2025 to our primary care practice requesting renewal of escitalopram drops. She had previously been followed by another general practitioner. During this period, she had run out of her medication and experienced a deterioration in mood after several weeks without treatment. Her depressive symptoms had originally emerged three months postpartum following her second pregnancy, persisted for more than two weeks, were associated with functional impairment, and continued for approximately five years. Given the delayed onset, duration, and severity, the presentation was considered more consistent with postpartum depression than transient postpartum “baby blues”. She lived in Switzerland for nine years. After her first pregnancy in her country of origin, she experienced postpartum depression but recovered with psychotherapeutic treatment without long‐term pharmacotherapy []. At the time of migration, she was asymptomatic. Following her second pregnancy in Switzerland, depressive symptoms emerged. Over five years, she declined psychiatric or psychological care, including counseling support. During this time, she received only intermittent primary care management and was prescribed antidepressant medication. Prior antidepressant trials with citalopram and bupropion had been discontinued due to adverse effects. The patient's prescription for escitalopram was continued at the time of presentation, with the dosage reduced to 7 mg to mitigate the potential for adverse effects. This adjustment was made considering the patient's previous good tolerance to the medication. At presentation, as previously, she refused specialist referral and psychological therapy, preferring primary care management. On this occasion, she wished to pursue this management more consistently regarding medication, follow‐up and coping mechanisms. She aimed to cope by engaging in hobbies, making self‐directed lifestyle adjustments, and drawing on the support of her partner and family, while maintaining consistency. The patient consented to a comprehensive somatic evaluation. On physical examination, the patient was in good general clinical condition. Vital signs were within normal limits. She appeared well‐groomed, calm, cooperative, and fully oriented. General physical and neurological examinations were unremarkable. Thyroid function tests were within normal limits, and no evidence of systemic inflammatory disease or other relevant systemic pathology was identified. Mental status examination revealed a depressed mood with mildly reduced psychomotor activity and a mood‐congruent affect. Speech was normal in rate and volume, and thought processes were coherent and goal directed. There was no evidence of psychotic symptoms or acute suicidal ideation. The patient reported occasional longstanding passive suicidal thoughts without distress, intent, or loss of control. There was no history suggestive of bipolar disorder, psychotic disorder, or substance use disorder. At presentation in June 2025, the Patient Health Questionnaire‐9 (PHQ‐9) score was 21, consistent with severe depressive symptoms. The patient declined referral for structured psychiatric diagnostic assessment. No formal DSM‐5 interview was performed. Management in primary care was therefore based on longitudinal clinical assessment, symptom history, and repeated PHQ‐9 measurements.