Labetalol, a drug with alpha- and beta-adrenergic receptor blocking effects, was used to attenuate hypertension and tachycardia associated with electroconvulsive therapy (ECT) in a series of 11 elderly patients with refractory depression and cardiovascular disease in a placebo-controlled, double-blind crossover study design. As compared with placebo, labetalol was found to blunt mean arterial pressure (MAP) increase by up to 8.26% (p less than .001), heart rate increased by up to 26.07% (p less than .001), frequency of atrial arrhythmias by up to 100% (p less than .01), and premature ventricular contractions by 41.97%. No untoward side effects were observed, and no effect on treatment outcome was noted. Labetalol appears to be an effective and safe agent to use in decreasing hypertension, tachycardia, and possibly arrhythmias in high-risk medical patients with cardiovascular disease undergoing ECT.