BACKGROUND Despite evidence suggesting that perceptual body image measurements are strongly associated with depression, few studies examined the association between perceptual body image and depression in adults. This study aimed to investigate the association of different measures of perceptual body image measurements with depression. METHODS We analyzed data of 22,735 adults participating in the National Health and Nutrition Examination Survey between 2005 and 2016. Depression was ascertained using the validated Patient Health Questionnaire (PHQ-9) and depression was defined as PHQ score 10. The associations of measured body mass index (BMI) and body image (i.e., self-reported BMI, BMI discordance, perceived weight, and desired weight) with depression were assessed using logistic regression. RESULTS Women perceiving themselves as overweight or reporting their BMI as obese had significantly higher odds of depression (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.17-1.72 and 1.29, 1.04-1.60, respectively) compared to women perceiving themselves as about the right weight or reporting their BMI as normal. The association between perceived overweight and depression was independent of measured BMI (OR 1.37, 95% CI 1.09-1.72). Men perceiving themselves as underweight had higher odds of depression (OR 1.50, 95% CI 1.06-2.11) than men perceiving themselves as about the right weight. In women, but not in men, measured obesity was associated with higher odds of depression. LIMITATIONS The study's cross-sectional design and missing information on comorbidities. CONCLUSION Weight perception (in women and men), measured BMI and BMI discordance in women are associated with depression..