The authors review the use of ECT with nine seriously depressed patients at the National Institute of Mental Health over the past 8 years. Despite the patients' poor prior response to a variety of pharmacological treatments, only one patient failed to show a complete response to ECT. With most patients, improvement was quite rapid and dramatic, and all of the ECT responders were free of depression for at least 1 year after treatment. These results are consistent with previous studies; they deserve reemphasis now in light of recent controversies over ECT, including legislative and judicial attempts to restrict its use.