Dear Patti,

We’re three teenage boys writing about our Grandma Connie. Technically she’s our step grandmother. She’s lived with us ever since our stepdad Rob married our mom five years ago.

Grandma Connie can be hard to deal with. Sometimes she’s a pushy pain in the ass and we can’t stand her. She can be strict and nagging and gets angry about the tiniest things. Even our mom agrees. But we know Grandma Connie loves us. She doesn’t have any other grandchildren. She comes to all our games, helps us with homework, works hard all day, and tries to help us.

åthe time right now and always seems to be tired. Our mom took her to the doctor recently and they said that she is physically healthy but has something called dysthymia. It’s a kind of depression. The doctor gave her anti-depressant medication and said she should go to psychotherapy.

All three of us feel bad now that we’ve given her such a hard time. She always helps us but we don’t do much for her. How can we help her with her depression? Whatever we can do, we want to try. She’d do the same for any of us.

— Gabe, Eddie and Arlo

Dear Gabe, Eddie and Arlo,

How heartwarming to witness all three of you brothers and your wholehearted commitment to your Grandma Connie. That is extremely important as supportive loved ones are an essential key to recovery from depression.

The disorder your grandmother is dealing with is a chronic form of depression. Dysthymia is less extreme and less intense than a major depressive disorder. Its symptoms, however, are similar. Dysthymia is less debilitating but can last for long periods and, like major depression, can cause individuals to have a downcast mood and loss of energy. Although these are symptoms of a disorder, at times it may be difficult for loved ones not to take these moods personally.

Your grandma may also lose interest in things she used to find pleasurable, have difficulty concentrating, be indecisive or negative, and have a poor opinion of herself right now. Her appetite and weight may have increased or decreased, and she may sleep too much or have trouble sleeping.

People suffering from depression often have an inner voice that is harsh and demands that they be perfectionists. To counteract these negative thoughts, they need empathy, acceptance, respect, and love from their loved ones. Help her to replace this punitive voice with a loving one by not being overly critical and gently reminding her to be warm and kind to herself, as she deserves it.

Listen to her, if you can in a non-judgmental way. If she shares her thoughts and feelings, give your full attention. When she’s in pain and despair, you don’t have to do or say anything special; just be there for her. Offer to help with housecleaning like vacuuming or doing the dishes. Having a dirty or messy home may make her feel more worthless and discouraged. With a clean living space, she’ll have less to worry about. Encourage her to delegate tasks to the three of you.

The whole family can help support her in maintaining good eating and sleeping habits as these are important components in managing mood stability. Fatigue and hopelessness make it easy to procrastinate, but putting things off will eventually cause anxiety and guilt, which increases depression. Maybe your parents as well as you young men can gently encourage her to follow through on important actions.

Psychodynamic, insight-oriented, or interpersonal psychotherapy can enable her to sort out the feelings that are behind her symptoms and to explore those feelings, no matter how painful. Therapy is also helpful in the treatment of depression as it examines and corrects many of the self-critical thought patterns and views that people with mood disorders typically experience. It’s important that your grandma be encouraged to communicate freely with her therapist. She might also want to join a support group and learn stress reduction techniques.  

Since this is a difficult time for you boys, you might consider professional counseling for yourselves. Often through the challenging experience of protecting and nourishing a family member, an even deeper love can develop.

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has an office in Pasadena. Contact her at (626) 584-8582 or email Visit her website,