In 2001 the Second Edition of the American Psychiatric Association's Task Force Report on ECT maintained that no absolute contraindications to ECT exist. They warned, however, that ECT in persons with elevated intracranial pressure should be considered on a case-by-case risk to benefit ratio. Literature on the use of ECT in patients with elevated intracranial pressures is limited to space-occupying lesions as a cause for elevated pressures. This case report presents a 42-year-old woman with treatment-refractory major depression and idiopathic intracranial hypertension (also known as pseudotumor cerebri). Brain imaging and lumbar puncture were performed before ECT, and blood pressures were monitored closely during treatment. Treatment was successful with minimal adverse effects. With appropriate clinical observation, patients with idiopathic intracranial hypertension can be considered for ECT.