Several methodological limitations make it difficult to investigate in randomised, controlled studies whether antidepressants affect (increase or decrease) suicidality. Different kinds of studies (epidemiological, quasi-experimental intervention, naturalistic follow-up, etc.) should therefore also be considered in order to obtain the most comprehensive evidence. Taken together, these different approaches supply reasonable evidence that antidepressants are able to reduce both suicidal ideation and suicide in depressive patients. Data on suicide attempts are not robust enough to draw clear conclusions. Even though there are no consistent indications from the different study types of a suicidality-inducing effect of SSRIs or antidepressants in adults in general, the principle possibility of such an adverse effect in single cases or in subgroups of patients should be considered carefully. Different mechanisms could principally lead to suicidality-enhancing effects, for example the pharmacological mode of action related to different transmitter systems, to special pharmacodynamic properties like activating/drive-enhancing effects or to side effects like akathisia. Special dispositions of patients, i.e. personality disturbances such as borderline personality disorder, comorbidity, non-response, bipolarity and other factors, should be considered. In everyday clinical practice the discussion about the possible risks of the SSRIs or antidepressants in general should not result in clinicians forgetting the benefits of these drugs, especially their lower lethal toxicity profile. This is a great advantage, especially in cases with severe suicidality where the choice of a less toxic antidepressant helps to avoid the risk of fatality if the patient should misuse the antidepressant for a suicide attempt.