As socioeconomic development accelerates, various types of accidents have emerged, and rescuers are increasingly burdened with the task of reacting to sudden disasters. Constantly in a state of duty and combat readiness, rescuers experience intense mental strain. This has led to a range of adverse psychological reactions such as anxiety and depression, making mental health issues increasingly prominent among rescuers. For instance, during the Wenchuan earthquake rescue operation, the incidence rate of depression was 38% among personnel engaged in relief work. Rescuers’ psychological issues are worthy of significant attention, as neglecting them can severely impact the safety, stability, and combat effectiveness of rescuers.
Currently, although there are multiple approaches for treating depression, each has its own limitations. Literature indicates that the existing monoamine antidepressants have shortcomings such as slow onset, numerous adverse reactions, and the need for long-term medication. Additionally, new rapid-acting antidepressants may pose risks of drug addiction and neurotoxicity[8]. Acupuncture and acupoint stimulation primarily focus on treating primary depressive disorders, yet lack robust evidence regarding their effectiveness[9]. Other therapies such as psychological interventions often have slow efficacy and poor compliance. Consequently, alternative treatment methods for depression are urgently needed. Compared with other therapies, nutritional interventions offer advantages such as safety, convenience, and patient acceptance. It also reduces the adverse effects associated with pharmacological treatments. Therefore, nutritional intervention can be considered as a supplementary approach to antidepressant therapy. However, few clinical trials have investigated nutritional interventions for depression till date.
Depression is caused by long-term worry, fatigue, anger, panic, and other extreme emotions, resulting in qi and blood loss, zang-fu dysfunction, and disease, often mixed with excess and deficiency syndromes. Excess syndromes are mainly liver depression, fire excess, qi stagnation, blood stasis, and food stagnation, while deficiency syndromes are mainly qi and blood deficiency. Treatment is mostly used to tonify the heart, regulate the spirit, soothe the liver, strengthen the spleen, regulate qi, and eliminate phlegm[10]. This study employed a compound edible paste, with red rose, Seville orange flower, and sea buckthorn as the main components, for depression intervention, drawing from traditional Chinese medical texts such as Chinese Medicine Chi, ShenNong’s herbal classic, and the Compendium of Materia Medica. According to these texts, double-petaled red rose regulates qi and relieves depression and despair; Seville orange flower soothes the liver, regulates qi, and lowers lipids; red yeast rice invigorates blood circulation, relieves stasis, and strengthens the spleen; peach kernel breaks blood stasis, moistens dryness, and lubricates the intestines; Cordyceps nourishes the lungs and kidneys, lowers blood pressure, and calms the spirit; Angelica dispels wind, dries dampness, moistens the intestines, and facilitates bowel movements; sea buckthorn activates blood circulation, relieves stasis, transforms phlegm, and expands the chest; hawthorn promotes qi circulation, relieves food stagnation, and dissolves stasis; and licorice moderates urgency, detoxifies, and harmonizes the other herbs; all these herbs show great promise for future applications.
Literature also supports these findings: Liang et al.’s[11] research isolated and detected a high proportion of flavonoids from roses, which are highly similar in structure to antidepressant compounds. Yan et al.[12] discovered that roses possess pharmacological actions such as antioxidation, anti-tumor, anti-inflammation, anti-atherosclerosis, immunoregulation, liver protection, cardiovascular protection, and health functions like lowering blood sugar, lipids, regulating insulin, and improving skin against aging. Zhang et al.[13] conducted studies on the mechanisms of Schisandra and rose in repairing intestinal barriers and improving inflammation levels in depressed mice, confirming that their antidepressant effects are potentially linked to repairing intestinal mucosal barriers, reducing the release of intestinal inflammatory mediators, and increasing the levels of 5-HT and BDNF in the hippocampus. Costa et al.[14] found that Seville orange flower essential oil had antidepressant effects on mice. Yang et al.[15] used the “Five-Flower Soup” (rose, Seville orange flower, Albizia flower, Campsis flower, and chrysanthemum) for its liver-soothing and depression-relieving effects to treat various diseases. Li et al.[16-17] discovered that cordycepin has rapid and significant antidepressant effects on mice, and it exerts its effects faster than current clinical antidepressants, with stable and sustained effects without side effects. Sun et al.[18] found that Cordyceps polysaccharides can lower the levels of acetylcholine and glutamate salts and increase the level of 5-hydroxytryptamine in the brain, thereby producing sedative and hypnotic effects in mice. The flavonoid-rich part of sea buckthorn (SBF) stimulates neuronal cell differentiation and simulates the function of neurotrophic proteins in cultured neurons. In a mild stress-induced mouse model, ingestion of SBF reversed depressive behaviors in mice[19]. With the development and promotion of traditional Chinese medicine, an increasing amount of research has shown that traditional Chinese medicine compounds or traditional Chinese medicine extracts can affect gastrointestinal nerve function by regulating the intestinal flora and improving nervous system diseases. For example, the Xingpi Jieyu formula can maintain normal tryptophan metabolism and exert an antidepressant effect[20]. In recent years, research on the antidepressant effects, structure-activity relationships, and related mechanisms of flavonoids has increased dramatically. Many studies have reported that the total flavonoids extracted from Gancao (Gly-cyrrhizae Radix et Rhizoma), Suanzaoren (Ziziphispino-sae Semen), Xuancao (Hemerocallis Fulva), Yuxingcao (Houttuyniae Herba), and other functional foods, medicines, and homologous food products have significant antidepressant activity[21].
This study demonstrates that after six weeks of consuming a compound edible paste, the median SDS score among rescuers decreased from 63 to 35. This suggests that nutritional intervention might be effective in the early stages of depression among those who initially screen positive. This finding aligns with Zhang’s research[22], in which the intervention group of patients with depression treated with modified Xiao Yao pills for 12 weeks saw their SDS scores drop from 72 to 51. Similarly, Liu’s[23] study on patients with coronary heart disease accompanied by depression treated with the ShuGanJie Yu Decoction showed a reduction in SDS scores from 45.82 to 27.17. These results not only align with the effectiveness of these two traditional Chinese medicine treatments but also indicate a greater decrease in SDS scores after treatment with the paste, suggesting its potential in treating depression. This study provides robust clinical evidence and technical support for the use of nutritional formulas to alleviate depression.
This study has extensive and far-reaching military value, social benefits, clinical application value, and scientific research value. For the military, this study could provide powerful tools for maintaining the mental health of rescuers in complex and stressful environments such as comprehensive drills and practical confrontations. The study can also help reduce depression scale scores in rescuers, ensure smooth daily training and task execution, and enhance the cohesion and combat effectiveness of the troops. Regarding social benefits, early detection of depression and interventions to treat it can reduce the burden on families and society and rebuild confidence and positive attitudes in rescruers. Regarding clinical application, the nutritional intervention was easy to perform and could provide patients with safer treatment plans with better compliance. Regarding scientific research, it could provide researchers with new ideas and broaden their directions for depression treatment. In the past two years, our group has carried out research to provide evidence support[24-26].
Regarding contributions, first, this study selected rescuers with SDS-positive initial screening for early intervention, which can help identify and intervene in the depression status of rescuers earlier. Second, it takes the lead in applying nutritional formulas to intervene in the depression status of rescuers and explore their intervention effect for the first time.
The study has some limitations. First, no long-term follow-up was conducted to verify the long-term effects of the intervention measures. Second, this study is a single-center study, and our research will further validate it using subsequent multicenter data. In the future, our research team will conduct more research on various intervention methods to provide more evidence regarding the efficacy of early nutritional interventions to treat depression in rescuers.