Alyssa N. Bialek, MHS, MPH, PA

We don't yet know what causes depression, but it's thought that it is a combination of genetic, biological, environmental, and social influences. Because of this, the most effective treatments for depression combine medication with psychotherapy. Therapy, especially cognitive-behavioral therapy, can be extremely helpful in resolving the negative thoughts and feelings that come with depression. It gives patients new tools that they can use themselves to cope when their depression is making them feel down.

Some of the common medications used to treat depression include antidepressants such as SSRI's (Prozac, Paxil, Zoloft) or atypical antidepressants (Cymbalta, Wellbutrin). It's important to remember that these medications have different effects on everybody, and no one medication works right for everyone. Patients may have to try a couple before finding the one that works just right for them. If the first medication they try doesn't work, they should talk to their doctor about trying something else. In extreme cases where medication is not enough, electro-convulsive therapy and hospitalization may be the answer to keeping a severely depressed person safe.

Depression is a difficult illness to deal with, but it is more common than believed and there are many people who can help. With the right treatment, individuals with depression can get back to fully enjoying life again.

Enteroscopies may be used alone or in combination with other procedures. For example, if a doctor suspects malignancy (cancer) in the small bowel, she may use an enteroscope to take a sample of tissue from the small bowel and have it examined in a laboratory. If there is a blockage in the small intestine that cannot be surgically removed, an enteroscopy-guided stent placement may help relieve some of the symptoms associated with the obstruction. Enteroscopes may also be used to treat intestinal bleeding and remove abnormal growths like tumors and polyps, as well as foreign objects that might have found their way into the small bowel.

There are several ways to perform an enteroscopy:

• Push enteroscopy involves the use of a long tube with a camera, called an enteroscope. Depending on the location of the problem, the enteroscope is either passed through the mouth or rectum. This technique is often used to detect and stop bleeding in the upper small intestine.
• Balloon enteroscopy uses scopes that have tiny balloons at the tip. The balloons inflate and deflate to help make the passage of the scope into the small bowel easier. This method is used when there is a need to access and treat certain parts of the small intestine that push enteroscopy cannot reach.
• Capsule enteroscopy involves swallowing a capsule with a tiny camera inside it. As the capsule travels through the small intestine, the camera records and sends images that are then downloaded and analyzed by the doctor. The capsule eventually leaves the body during bowel movement. If the doctor needs to visualize the entire small intestine, capsule enteroscopy is the only option. The only drawback to this technique is that it cannot be combined with any treatment.

Enteroscopy is typically performed at the doctor's office and takes about 20 to 30 minutes, but may take longer if combined with another procedure. Patients may have a sore throat for a few hours if the scope was inserted through the mouth. Normal activities may be resumed about 24 hours following enteroscopy.

IBS, or irritable bowel syndrome, happens when the muscles surrounding the colon contract too easily or frequently. The result is abdominal pain, cramps, diarrhea or constipation, gas and bloating. IBS attacks can often be brought on by specific triggers, so a key part of treatment is learning which foods trigger IBS attacks and avoiding them. Treatment also includes exercise, avoiding stress, and medications if needed.

Constipation, or large, hard, or infrequent stools, happens to everyone at some point. It can be caused by a disruption in routine or food, or by eating a diet without many fresh fruits and vegetables. Although it is uncomfortable, constipation is common and usually not serious, but it can sometimes become chronic. Adding fiber to the diet, exercising, and taking medications may help.

GERD, or gastroesophageal reflux disease, is a severe form of chronic heartburn where stomach acid spills back up into the esophagus. Left untreated, the acid may even eat away at the esophagus and cause serious damage. Treatment includes changing the diet to avoid trigger foods, losing weight if needed, medications, or even surgery.

Hemorrhoids are blood vessels around the rectum that become irritated, swollen or torn while straining during a bowel movement. They are most often caused by constipation, but can also be caused by pregnancy, diarrhea, or simply a genetic predisposition towards hemorrhoids. Treatment involves first treating any constipation issues, then keeping the area clean and soothed until it has healed. If these measures are ineffective, surgery is sometimes used.

Peptic ulcers are sores or spots of inflammation in the lining of the stomach or close to the stomach in the small intestine. Usually this area is coated with a protective lining that shields the tissue from the strong stomach acid, but a break in the lining can let acid in, causing the sores. It used to be thought that stress caused ulcers, but now it is known that is not the case. Most often, they are caused by an infection by H. pylori bacteria, but ulcers can also be caused by alcohol abuse or overuse of aspirin, ibuprofen, naproxen, or other NSAIDS. The symptoms of an ulcer are pain, hunger, nausea, and fatigue.

Gastrointestinal problems, perhaps more than any other area, are markedly affected by lifestyle. Many disorders can be prevented or treated at least in part by eating a healthy diet high in fiber, exercising regularly, drinking enough water, and limiting alcohol intake. Still, the frequency of digestive disorders means that even the healthiest person can be affected by them. Anyone who notices blood in their stool, experiences abdominal pain, unexplained weight loss, or any significant change in bowel movements should see a doctor.