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Depressive realism suggests that depressed individuals may make more accurate or realistic judgments than nondepressed counterparts. This meta-analytic study (130 articles, 151 samples, N = 33,043) synthesized findings on the relation between depressive mood and the accuracy of judgment, and investigated the conditions under which depressive realism or its opposite-depressive distortion-emerges. Overall, results indicated a weak but significant depressive distortion effect (Hedges's g = 0.09). Moderator analyses showed that the depressive realism was more likely when tasks involved control or contingency judgments, were analytically complex, and self-referent. By contrast, depressive distortion was more likely in severe clinical depression, with tasks that were non-self-referent, low in complexity, or involved ambiguous social information. Notably, distortion effects were more often observed in studies that did not acknowledge depressive realism. This review clarifies mixed findings on the depression-accuracy relation by identifying task-specific moderators, offering implications for theory and clinical practice.