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Koki Takagaki,1 Yasumasa Okamoto,1 Ran Jinnin,1 Satoshi Yokoyama,1 Atsuo Yoshino,1 Fumi Kagawa,1 Yuri Okamoto,2 Yoshie Miyake,2 Shigeto Yamawaki1 1Department of Psychiatry and Neurosciences, Hiroshima University, Hiroshima, Japan; 2Health Service Center, Hiroshima University, Hiroshima, Japan Background: A Japanese study revealed that 20.7% of first-year undergraduate students had a major depressive episode during the previous 12 months: first-year undergraduate students with depression need early support. Reportedly, antidepressant medication use during adolescence is associated with modestly increased risk of suicidality. This case study of a late-adolescent woman with depression illustrates the effects of behavioral activation without psychotropic medication.Case presentation: A first-year undergraduate student was diagnosed as having major depressive disorder. From earlier studies, we developed a behavioral activation program for late-adolescent people with major depressive disorder. Behavioral activation administered in 10 weekly 60-minute sessions decreased depressive symptoms, avoidant behaviors, and rumination. Moreover, the Beck Depression Inventory, second version score was 1 at 1-year follow-up.Conclusion: Results of this case study show that behavioral activation is effective without psychotropic medication. Future studies of large samples must be conducted to assess the effectiveness of behavioral activation without psychotropic medication for depression in late adolescence. Keywords: avoidant behavior, behavioral activation without psychotropic medication, major depressive symptoms, rumination