Antidepressants are commonly prescribed in primary care and it is important to understand the relationship between race and antidepressant prescriptions in integrated primary care systems. We found that Black Veterans were almost two times less likely to have an antidepressant prescription as compared to White Veterans, when controlling for depression symptoms, demographics, psychosocial variables, and other clinical symptoms. Among Veterans with none to mild symptoms of depression, White Veterans were more likely to have an antidepressant prescription as compared to Black Veterans, suggesting that White patients may be receiving potentially unnecessary care. Among patients with severe depression, Black Veterans were less likely to have an antidepressant prescription as compared to White Veterans, suggesting that Black Veterans are not yet receiving care in line with clinical guidelines. Racial disparities in the provision of mental health care persist and future research should seek to identify and address these disparities systematically.