Because the incidence of major depression and cardiovascular disease both increase with age, many electroconvulsive therapy (ECT) patients present with significant cardiovascular risk factors. Hypertension and cardiac events have been the leading cause of death in reports of ECT-related mortality (Barker and Baker, 1959; Malik, 1972). The purpose of this review is to examine the specific pharmacologie interventions that may be indicated, either to manage existing disease or to attenuate the cardiovascular responses to the treatment itself.