A 74-year-old woman with essential hypertension underwent a course of electro convulsive therapy (ECT) for the treatment of psychotic depression. Her treatments were associated with delayed and significant hypertension. Clonidine, which controlled her baseline blood pressure, was inadequate in treating her post-ECT hypertension. Acute treatment with hydralazine also failed. Labetalol, a short-acting beta-blocking agent with some alpha-1 blocking activity, worked well both acutely (intravenously) and orally to manage essential and ECT-induced hypertension.