We report the case of an 81-year-old woman, suffering from a major depressive episode and incipient Alzheimer disease, whom we treated with ECT without interrupting therapy with the acetylcholinesterase inhibitor (ACHE-I) rivastigmine. After eight right unilateral ECT sessions, the patient remitted completely without any significant deterioration of memory and cognitive abilities or cholinergic side effects. This report demonstrates that ECT was safely used in one elderly and mildly demented person with continuous ACHE-I therapy. The hypothesis that this drug may indeed protect against unfavorable side effects of ECT should be further tested in clinical trials.