Analysis of 358,425 long-term care residents with depression found that 81.7% received pharmacological treatment, primarily selective serotonin reuptake inhibitors (59.8%) and miscellaneous antidepressants (42.3%). However, significant disparities emerged: Black or African American residents and those in facilities serving socioeconomically disadvantaged areas had lower odds of receiving treatment, while residents with certain comorbidities like vascular dementia showed higher treatment rates. These findings illuminate persistent inequities in geriatric depression care that warrant urgent attention. Depression affects up to 50% of nursing home residents and substantially impacts quality of life, yet treatment patterns remain poorly understood in this vulnerable population. The study's large scale provides robust evidence of systemic disparities that may reflect broader healthcare inequities. However, as an observational analysis, it cannot establish whether treatment differences reflect appropriate clinical decision-making or discriminatory practices. The medication-focused approach also doesn't capture non-pharmacological interventions. Since this is a preprint awaiting peer review, these concerning disparities require verification through the formal review process. If confirmed, the findings suggest that addressing structural barriers and implicit bias in long-term care settings should be prioritized to ensure equitable depression treatment for all residents.