Antidepressant drugs provide relief to depressed patients. However, they have been historically blamed to cause worsening or an emergence of suicidal behavior. This has been a keen concern in recent years, especially in the pediatric population. There have been many studies regarding this issue and evidences have been equivocal. Several mechanisms of action for the suicidal behavior have been proposed. Clinical characteristics suggestive of vulnerable patients have been identified. The current review is an attempt to gather available evidence to help the clinician to arrive at an appropriate treatment decision while weighing the risk-benefit ratio of prescribing antidepressant drugs.