Oh boy - I can talk to you about anxiety. I'm so sorry for your brother - do everything you can to get him help. Has he had this all of his life or recently developed it? Often it starts due to a triggering event. For me, it was multiple events, a bad airplane flight where a bathroom was broke and people were standing up in the aisles while I was sitting (total claustrophobia)and my biological clock screaming with no potential husband in sight. At first the anxiety wasn't so bad, but as my biological clock ran down, then I lost my job, it got really bad - claustrophobia especially and anxiety about everything. Then my boyfriend and I broke up (my last chance for biological kids with a husband due to my age) and my dad almost died - talk about a recipe for anxiety!
Does anyone else in your family have issues - anxiety and depression are known to run in families. My grandma, mother, uncle, brother and aunt all have anxiety/depression issues. I had two previous episodes at age 11 and age 19 during times of turmoil, but I didn't recognize them. This time, I couldn't stop crying and was a nervous wreck, started to become agorophobic (didn't want to go far from the house - only felt safe at home.) I got to a good therapist and she had a doctor in her group who recognized that it ran in my family and prescribed Lexapro for me - 10 mg. I've been on it ever since and it works wonders. It has really helped me as I've continued to see my therapist (I now have a great job, but am going through fertility treatments after deciding to have a child on my own). I LOVE Lexapro. I've had no side effects. I did go off it for a year when I first started fertility treatments, but then I got pg and was nauseous and couldn't sleep and the anxiety came roaring back.
Two things are so important - sleep and exercise. Really. Even on the medication, when I don't get enough sleep for a night or two I can feel the anxiety increase a little. I'm sure the lack of sleep is totally exacerbating your brother's depression and anxiety. And the exercise boosts how I feel about myself. I have to force myself to do it sometimes - I tell myself, though that it's like someone who has a bad shoulder - I need exercise for my mental health the way someone else needs physical therapy for a damaged part of their body.
I think because I had seen depression and anxiety in my mother and other family, I recognized it in myself - but only after it got pretty bad. I was able to express myself to friends and family and they encouraged me to see someone, so I did. I don't know where you live but I would go see your brother right away and find out about his medical insurance, who his medical group is, if he's at a college and that's all the coverage he has(for the college clinic) go to the clinic with him and see what they recommend. When all of this happened to me, I was unemployed and running out of money to pay my mortgage, but through the county, they have a family services center that asks you to pay on a sliding scale. At first I paid $5 a visit. Then as I got a job, it went up to $20. When my full coverage kicked in, I moved to a new therapist covered by my insurance. There is help out there, but at his age, he wouldn't know where to look. Someone has to be there and help walk him through this, get him to a doc. He needs treatment - I'm not sure if he needs inpatient treatment - he may just need to see someone twice a week as an outpatient and perhaps see a better doc to get the right meds. Don't give him a book and expect him to handle it on his own. If he could do that, he would have done it already.
I remember when I first was getting treated and they talked about exercise and intellectually I knew exercise was very good for mental health, but emotionally I was so depressed, I was hopeless and didn't care. I literally had to reach deep down inside to force myself to work out - with the encouragement of my therapist.
I don't know what the background is of your brother, but clearly he's in college, on his own, things aren't going well, probably started spiraling down with him not getting enough sleep, then the grades start slipping, it's a snowball effect, he doesn't know what to do. But definitely get in there before something happens. I was having suicidal thoughts because I was so hopeless - no job, no Mr. Right, no kids, and I was watching everyone else's life go forward, friends got engaged, married, bought houses with husbands, got pg, had baby showers and there I was - nothing - my life felt so negative. But, here I am, several years later, although my biological clock did end, I grieved it and have found a way to move on and try to have children via donor egg. I still haven't found someone to spend my life with, which sometimes makes me sad, but sometimes I think, well, maybe after I have a child I'll meet a nice divorced guy with kids who still wants to be a dad and husband...I'm overall pretty happy given a difficult few years.