The history of the practice and the guidelines of electroconvulsive therapy (ECT) in Japan is reviewed in this paper. Although the practice of ECT began in Japan at the same time as the discovery of ECT in the world, the diffusion and buildup of ECT practice did not progress in comparison with this treatment modality worldwide for a long time. Recently, the establishment of the Japanese ECT guidelines, which emphasize the administration of a modified ECT using a brief pulse device, has been underway. In 2009, the first ECT network meeting was held in Tokyo, which helped to stimulate the development of ECT practice and improve the guidelines for its use in Japan.