OBJECTIVE: Two percent of all children and 4% of all adolescents in the United States have been diagnosed with Major Depressive Disorder (MDD). Unfortunately, many children and adolescents who have MDD never receive proper treatment. Of those who do receive treatment, antidepressants are commonly utilized. In October, 2004 the US Food and Drug Administration (FDA) issued a Public Health Advisory to warn that increased risk of suicidal thoughts and behaviors may be associated with the use of antidepressant medications, including SSRIs, in children and adolescents. Since this warning is based, in part, on the hypothesis that the use of SSRIs may increase the risk of suicidality (thoughts and behaviors), this review examines how suicidality has been measured in randomized controlled trials (RCTs) of SSRI use in children and adolescents with MDD. METHODS: The tiered search strategy included RCTs published between January 1, 1985 and October 31, 2004. Three electronic bibliographic databases (Medline, PsycINFO, and Dissertation Abstracts) and the Cochrane Libraries were searched for research articles meeting the defined inclusion criteria for children and adolescents. RESULTS: Eight randomized controlled trials met the inclusion criteria. All eight studies had a general recording of adverse events, but only four utilized one or more formalized measure(s) of suicidality. Two of the measures consisted of only one item related to suicidal ideation, and not all measures used had been previously validated. CONCLUSIONS: No consistent methods for defining or measuring suicidality were employed across studies, even those used to rationalize the FDA warning. Furthermore, when suicidality was measured, only a part of suicidality was formally measured. Future research should utilize consistent definitions and validated measurements of suicidality so that the risks associated with SSRIs in children and adolescents with MDD will be accurately understood and effectively compared.