Antidepressant treatment of the depressed geriatric patient can be complicated by concomitant medical illness. We report the successful administration of electroconvulsive therapy (ECT) in three depressed geriatric patients who received the oral anticoagulant warfarin (Coumadin) for cardiovascular disease. The physiologic changes associated with modified ECT and risk factors for intracerebral hemorrhage in patients receiving anticoagulants are discussed.