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Electroconvulsive therapy (ECT), a treatment for severe mental illness in which a brief application of electric stimulus is used to produce a generalized seizure, has been in use for over 45 years. Controversies still exist today concerning the use of ECT. In 1985, the National Institutes of Health and the National Institute of Mental Health held a Consensus Development Conference on Electroconvulsive Therapy. A consensus panel representing psychiatry, psychology, neurology, psychopharmacology, epidemiology, law, and the general public considered scientific evidence presented by ECT experts. The panel agreed that: (1) ECT is effective for a narrow range of psychiatric disorders in the diagnostic categories of delusional and severe endogenous depression and manic and certain schizophrenic syndromes; (2) ECT side effects include acute confusional states and persistent memory deficits for events during the months surrounding the ECT; (3) physicians and patients considering ECT should participate in an ongoing consultative process and consider advantages and disadvantages of ECT; (4) proper administration of ECT can reduce side effects while maintaining therapeutic effects; and (5) future research in ECT should examine the basic mechanisms by which ECT works, patients for whom ECT is particularly beneficial or toxic, and how to maximize efficacy and minimize side effects. (NB)