Clinical outcome of 84 elderly unipolar depressed patients who had received electroconvulsive therapy (ECT), with or without concurrent tricyclic antidepressant medication, was reviewed retrospectively to discover if predictions based on preclinical studies of increased efficacy with combined treatment would be supported. Global outcome at discharge was improved for those patients who had received tricyclic antidepressant drugs concurrent with ECT. They also required fewer ECT treatments to achieve that improvement. Total seizure times were markedly reduced for the combined therapy group, which was an unexpected finding.