Electroconvulsive therapy (ECT) is a safe, rapidly acting, and very effective form of treatment for severe affective illness. In recent years the limitations of available psychopharmacotherapies and the pressures of cost containment appear to be encouraging the increasing use of ECT. The authors provide an overview of electroconvulsive therapy as a treatment modality, focusing on indications, contraindications, adverse effects, and contemporary ECT technique, including recent modifications in electrode placement, stimulus wave form, and dosage intensity. They urge that adequate training be provided for medical and nursing personnel who administer ECT and that facilities monitor practitioners' competence by specific privileging.