SummaryIn a retrospective case control study, clinical features of postictal excitement following electroconvulsive therapy (ECT) were examined in 24 patients and 24 matched controls. The two groups did not differ in clinical outcome, degree of pretreatment agitation, anesthetic or succinylcholine dose, number of ECTs received, mean seizure duration, number of titrated treatments with subconvulsive stimulation, or type of EEG ending. Patients who became excited early in the treatment course rarely manifested this phenomenon at all subsequent treatments. Within the “excited” group, a minority of patients became excited following the first ECT, and only 34.3% of their treatments resulted in postictal excitement. It may not be necessary to routinely use postseizure benzodiazepines in patients who have once exhibited a postictal excitement.