Objective To explore the effect of St. John' s wort extracts (SWE) on depressive disorder in el-der patients with unstable angina. Method A total of 170 patients, who fulfil the criteria, were enrolled in this prospective study. Patients were randomly assigned to SWE group (44 cases), Deanxit group (44 cases), psy-chotherapy group (42 cases) and control group (40 cases). The effectiveness of the treatments were evaluated with the reduced percentages of hamiltion depression (HAMD) scale and reduced frequency of angina pectoris attack,which were measured before and after 12 weeks of the above treatment. Results (1) The reduced percentages of HAMD scales were 79.5%, 56.8% and 57.1% in SWE, Deanxit and psychotherapy group, respectively. Com-pared with the control, the differences were significant (P < 0.01). The change in SWE group was even more sig-nificant than in Deanxit or psychotherapy group (P < 0.05). (2) Changes of angina pectoris evaluated by Canada Cardiac Society classification were significantly better in the treatment groups (88.7%,65.9%,57. 1%) than control group,and the change in SWE group was even more significant (P < 0.01). (3) Angina pectoris attack frequencies, durations and electrocardiogram changes were significantly better in the treatment groups than control group (F= 6.05,4.58,5.12,P < 0.01), and the change in SWE group was even more significant (P < 0.05). Conclusions Hie present study demonstrated that SWE can improve depressive symptoms signifi-cantly in elderly patients with unstable angina than Deanxit or psychotherapy, which also contribute to better man-agement of angina attack as well. Key words: St.John's wort extracts (SWE); Depression; Elderly patients; Coronary heart disease; Unsta-ble angina; Psychotherapy