Objective To explore the effects and safety of escitalopram on suicide-related symptoms for depression patients controlled with amitriptyline.Methods Depression patients with suicide-related symptoms were randomly grouped.The study group(n=35) were treated with escitalopram 10 mg/d to 20 mg/d and the control group(n=33) were done with amitriptyline 75 mg to 250 mg daily.Both groups with psychotherapy were carried out for 8 weeks' observation.The Hamilton Depression Rating Scale (HAMD-17) and Clinical Global Impression-severity of illness (CGI-SI) were tested and suicide-related examined before and after 1,2,4,6 and 8 weeks'treatment.The Treatment Emergent Symptom Scale (TESS) was checked at 4th week to evaluate safety.Results In the study group,the incidence of wishing to die (97.1％),suicidal attempts (91.4％),suicidal ideations (88.6％),suicidal plans (80.0％),hopelessness (71.4％) and suicidal behavior (54.3％) was similar to the control group(97.0％,97.0％,90.9％,87.9％,72.7％ and 54.5％,respectively,x2 =0.00-0.94,P＞0.05).The incidence of suicide-related symptoms showed significantly lower after treatment than before (P＜0.01).At 1st week treatment,the incidences of hopelessness (37.1％),suicidal plans (45.7％) and suicidal ideations (48.6％)showed significantly lower in the study group than those in the control group(63.6％,72.7％ and 75.8％,respectively,x2 =4.77,5.12,5.32,P＜ 0.05).The study group showed significantly lower side-effects (11.4％) at 4th weeks' treatment than the control group(62.9％,x2 =21.95,P＜0.01).Conclusion The effects of escitalopram on suicide-related symptoms for depression patients is similar to amitriptyline but with faster effect and higher safety.