The purpose of this study was to examine the reasons people with an episode of Major Depression do or do not seek treatment for the episode. We interviewed 101 persons who met criteria for an RDC Major Depressive episode that lasted at least 4 weeks within 3 years of the interview date, exploring in detail the reasons they gave for seeking or not seeking treatment. GAS ratings indicated that all subjects were moderately impaired at the time of the episode. We found that 55% of the subjects did not seek treatment for this episode, while 45% did. Significant predictors of treatment seeking included a history of prior treatment, higher education, and greater episode length. Non-seekers felt they could handle the episode themselves, did not consider it serious or did not recognize it as an illness. Seekers on the other hand felt the episode was too painful and lasted too long and caused significant disruption in their interpersonal relationships and role functioning. We discuss the implications of these findings in terms of the importance of continued educational efforts to encourage treatment seeking as well as the need for further research to explore the manner in which people decide that affective signs and symptoms have reached a threshold that leads to treatment seeking.