OBJECTIVE The aim of this study is to examine ethnic differences in depressive symptoms and antidepressant treatment in a cohort of patients undergoing diagnostic coronary angiography. BACKGROUND Coronary heart disease (CHD) is the leading cause of mortality in the United States, with an excess of mortality in African Americans. Traditional risk factors occur more frequently among African Americans but do not fully account for this increased risk. Elevated depressive symptoms have been shown to be associated with higher morbidity and mortality in patients with CHD. METHODS A consecutive series of 864 patients (727 whites, 137 African Americans) completed the Beck Depression Inventory to assess depressive symptoms. Data describing cardiovascular risk factors and type of medications including antidepressants were obtained from chart review at the time of study enrollment. RESULTS There was no difference in the severity of depressive symptoms between whites (P = .50); the prevalence of elevated depressive symptoms also was similar for African Americans (35%) and whites (27%) (P = .20). However, the rate of antidepressant use was 21% for whites but only 11.7% for African Americans (P = .016). The odds ratio for ethnicity (African American vs whites) in predicting antidepressant use was 0.43 (95% confidence interval 0.24-0.76, P = .004) after adjustment for Beck Depression Inventory scores. CONCLUSIONS African Americans with CHD are less likely to be treated with antidepressant medications compared with whites despite having similar levels of depression. The ethnic differences in the psychopharmacological management of depression suggests that more careful assessment of depression, especially in African Americans, is necessary to optimize care of patients with CHD.