SummaryIn this retrospective naturalistic study, clinical records were reviewed to examine the effects of unmodified electroconvulsive therapy (ECT) in 30 manic patients at a psychiatric institute in India. Twenty of the patients were experiencing their first episode of a major mood disorder. ECT was associated with complete remission of mania in 26 (87%) of the patients. The remaining four patients were discharged home with residual hypomanic symptoms. On average, the patients received 5.4 treatments, and the duration from initiation of ECT to discharge from hospital was 12.9 days. The number of treatments was not related to age, age at onset, duration of index episode prior to treatment, or presence of psychosis. No patient developed an organic brain syndrome or sustained a bone fracture during unmodified ECT. One month follow-up data were available in 27 of the 30 patients. Recurrence of manic symptoms following discharge occurred in three (11%) patients. For those in whom 3 month follow-up data were available, all 15 were in complete clinical remission. The induced convulsion, and not repeated administration of general anesthetics, is integral to the antimanic effect of ECT.