Older patients hospitalized with major depression in the U.S.A. are more likely to be treated with electroconvulsive therapy (ECT) than younger patients (Olfson et al., 1998; Thompson et al., 1994). Concerns have been expressed that ECT may be “overused” in these older patients, who may be especially sensitive to its physical and cognitive adverse effects. We selectively review the evidence on this issue, addressing several questions that are important for clinicians who treat older depressed patients. While ECT is used in other geriatric syndromes (e.g., depression in Parkinson's disease, bipolar depression, etc.), we focus exclusively on non-bipolar major depression because there is almost no published evidence relevant to these other conditions.