A 60-year-old man with psychotic depression became comatose following the administration of intravenous droperidol given for post-ECT delirious agitation. The differential diagnosis, which included neuroleptic malignant syndrome and the possibility that droperidol may have uniquely detrimental effects in the context of post-ECT delirium, are discussed. In light of recent publications advocating droperidol as the pharmacologic treatment of choice for severe agitation, this case illustrates a need for greater caution in its use for the treatment of post-ECT delirium.