The American Psychiatric Association's forthcoming practice guidelines for the treatment of patients with major depression identify electroconvulsive therapy (ECT) as an option for the treatment of depression after psychotherapy, medication trials, or both have failed or if associated psychotic or catatonic features are present, and where the need for response is urgent (e.g., patients who are suicidal or nutritionally compromised due to refusal of food or fluids). For bipolar patients with depression, existing APA guidelines suggest that ECT also represents a reasonable alternative for patients with life-threatening inanition, suicidality, or psychosis.