Electroconvulsive therapy (ECT) is becoming primarily a tool for treating major depressive illness, where there is substantial evidence for its success. The use of ECT to treat schizophrenia, mania and other conditions has markedly decreased, reflecting the development of effective drug treatment. Recommended indications for ECT are suicidal patients and those who refuse to eat or who are otherwise seriously disturbed or unmanageable. ECT is also indicated when chemotherapy has or is likely to fail or is contraindicated because of cardiac difficulties or pregnancy. ECT compares favorably with chemotherapy in terms of safety and effectiveness. The only absolute contraindication is raised intracranial pressure. Unilateral electrode placement using brief pulse current minimizes post treatment confusion and memory impairment.