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Depression affects 6.7% of the adult population each year and studies indicate the annual prevalence is similar or even higher in athletes. It is often insidious and not recognized. There continues to be stigma and misunderstanding about the disorder that is a barrier to getting an accurate diagnosis and effective treatment. It is important for people living with depression to get professional help because the condition itself can be disabling, increases risk of suicide, and reduces quality of life. There is some evidence that depression and suicide risk is higher in endurance athletes such as track and field, marathoner, and ultramarathoners. There have been studies of athletes looking at rates reporting depressive symptoms and on factors in suicide attempts in the athletes. Studies have reviewed risk factors unique to athletes for depression. This article will review depression in the endurance athlete and approaches in treatment in that population.