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Category: Psychiatry > Adult Psychiatry > Mood Disorders > Major Depressive Disorder
A 13-year-old boy is evaluated in the emergency department after texting a friend that he “doesn’t want to live anymore.” For the past 2 months he has had depressed mood, loss of interest in previously enjoyed activities, decreased appetite, fragmented sleep, and difficulty concentrating at school. He denies an active suicidal plan or intent and has not used any substances today.
Past medical history includes gastroesophageal reflux disease and migraine headaches treated with omeprazole and occasional rizatriptan. Three years ago, he completed a medically supervised buprenorphine taper for prescription opioid misuse and has remained abstinent.
Vital signs are temperature 36.4 °C, pulse 88/min, blood pressure 112/68 mm Hg, respiratory rate 18/min, and oxygen saturation 99% on room air. Physical examination shows a tearful adolescent with flat affect and psychomotor slowing; the remainder of the examination is normal.
Laboratory studies obtained to rule out contributory medical conditions (complete blood count, comprehensive metabolic panel, thyroid-stimulating hormone, and urine toxicology screen) are normal.
Additional history: His mother was treated for major depressive disorder that began in her teens. He lives with both parents, is largely sedentary outside of school, and reports occasional marijuana use at parties (last use 2 weeks ago).
The psychiatry team diagnoses a first episode of major depressive disorder, moderate severity, without psychotic features, and recommends initiation of psychotherapy with consideration of an SSRI.
Based on epidemiologic data in adolescents, which of the following is the single strongest risk factor for developing major depressive disorder?
**Occasional recreational marijuana use**
**Having a first-degree relative with major depressive disorder**
**Sedentary lifestyle with limited physical activity**
**History of childhood physical abuse**
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