hi.. thanks for writing.. i have understood your concerns... your brother is suffering form severe depression and in my opinion, he shud be taken to psychiatrist and admitted to psychiatric hospital for better treatment.. when in depression person has suicidal thoughts or gestures, then it is very severe condition he can commit suicide any time..he shudnt be left alone, someone shud always accompany him and talk to him..the life threatening objects like cutter, knife etc..shud be removed form his surrounding... the treatment options are antidepressant drugs and electroconvulsive therapy.. about the drugs: he shud be given tablet. sertraline [zoloft 50 mg] at night and gradually increased up to 200 mg in 1 to 2 months depending upon the improvement in symptoms.. along with it he shud be given sleeping pills, if he has difficulty in sleep.. like tablet zolpidem [ ambien 10 mg] at night.. antidepressants take 14 to 20 days to show their effects..so u shud look after him properly..there are chances that after starting the drugs, patient has improvement and decision taking also improves, so there are chances of suicide initially... so keep that in mind,,, but in my opinion if he has suicidal ideation then he can be best treated with ECT.. mild electric shock is given to both fronto temporal region..it is completely safe, given under anesthesia and there are no side effects..cure rate of 80%.. so i ll advice that u shud take him to psychiatrist by any means and admit him there..he might refuse but all this is for his best interest.. when he came out of suicidal thoughts, then he can consult a psychotherapist for cognitive behavior therapy.. i hope u ll find this advice helpful... best luck..