Rarely have we been exposed to a more bewildering array of data and opinions as over the past year on the subject of antidepressants in children. Ever more definitive meta-analyses and databases are published on a weekly basis. Researcher-clinicians of impeccable credentials look at the same data and deliver opposite opinions.

Let's face it. With our most troubled, desperate patients, each visit is an exercise in doing something that may very well be impossible: predicting whether they are going to attempt suicide.

Psychiatrists, once relatively immune from malpractice lawsuit, are being sued at an increasing rate. Only about 2% of psychiatrists were sued in 1975; this figure increased to 8% in 1995. And most of these suits are for negligence related to suicides.

Dr. Shea, in your classic book, The Practical Art of Suicide Assessment (John Wiley & Sons, 2002), you describe the CASE approach to evaluating suicidal ideation. What is the CASE approach?

Roger is a 52 year-old business owner in Massachusetts who has struggled with bipolar disorder and suicidal ideation through much of his life.

The suicide-prevention organization Samaritans was founded in 1953 in the UK by a Church of England vicar named Chad Varah. He writes, "It had been 18 years since I made my debut in the ministry by burying a 14-year old girl who'd killed herself when her periods started, thinking it was VD."