The case of an elderly woman who underwent successful electroconvulsive therapy (ECT) following bilateral adrenalectomy is presented. In contrast to previous animal and human studies, sharp rises in heart rate and blood pressure were observed immediately post seizure, despite pretreatment with nifedipine. These findings indicate that the hemodynamic changes typical of ECT are not necessarily dependent upon increases in circulating epinephrine, and they confirm previous assertions that the therapeutic effect of ECT is not dependent upon intact adrenal function.