Electroconvulsive therapy (ECT) is an effective treatment for various psychiatric conditions. Although rare, prolonged post-ECT delirium is a serious adverse effect of ECT. Various factors, such as underlying brain pathologies, medications, seizure duration, and type of electrode placements play a role in the development of post-ECT delirium. We report a 56-year-old male suffering from 14-day-long post-ECT delirium associated with substance misuse, pesticide exposure, as well as ischemic brain changes. On the basis of the insights from this case, it may be suggested that all patients should be screened for risk factors associated with ECT-related delirium before ECT and that various parameters, such as electrode placement and medications, should be adjusted accordingly.