Early literature on the use of electroconvulsive therapy (ECT) for mania is reviewed briefly, followed by an account of retrospective and prospective studies that indicate the usefulness of ECT in the treatment of mania. Case vignettes that involve patients with relatively mild manic illnesses are presented, followed by discussion of technical issues, side effects and complications, drug interactions, monitoring, special populations and circumstances, and regulatory aspects. The article concludes with a brief consideration of possible mechanisms of action.