The use of electroconvulsive therapy (ECT) at a university teaching hospital in 1970 and in 1980-81 was reviewed. The percentage of psychiatric patients who received ECT declined modestly over the period, from 4.4 percent to 2.9 percent, despite compelling evidence of its safety and efficacy. Its use as a first-line treatment appeared to drop markedly in 1980-81, however, as indicated by a significantly longer mean period of hospitalization before administration of ECT. Overall length of hospitalization was significantly longer for patients who received ECT in 1980-81. These patients were also more likely to have had previous psychiatric admissions, suggesting they may have been more seriously ill. The findings are compared with use of ECT in other settings.