Inclusion Criteria:

• Subjects must meet DSM-IV-TR criteria for major depression, single episode or recurrent
• Subjects must be over the age of 45 years
• Subjects must be willing to receive at least six treatments of ECT, along with pre ECT lab screening and pre and post psychological and neuropsychological tests
• The ability to read, speak and comprehend English and have the ability to complete the forms in writing
• Must be able to give consent for treatment
• Shorter acting benzodiazepines (aplrazolam, lorazepam) will be allowed on a prn basis but excluded 12 hours before each ECT session

Exclusion Criteria:

• Subjects who have a history of schizophrenia, bipolar affective disorder, delusional disorder, paranoid disorder, or schizoaffective disorder, or who are exhibiting psychotic symptoms [except mood congruent depressive delusions].
• Subjects who have a substance abuse/dependence disorder not in full remission
• Patients with significant medical problems that may increase risk or require unusual concomitant treatment
• Patients with significant neurological problems including seizure disorder
• Patients with a hearing or visual impairment that would interfere with the research process
• Patients with moderate to severe dementia. Any patient scoring less than 25 on the MMSE will have a Mattis DRS-2 test for dementia administered.
• Patients known to be intolerant of propofol, etomidate, or succinylcholine, or for whom these anesthetic medications are not appropriate
• Patients taking anticonvulsant medications such as Tegretol, Depakote, Klonopin, etc.
• Patients on an involuntary admission status
• Patients unable to give informed consent