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To clarify the implications of herbal alternative medicine use during electroconvulsive therapy (ECT).A substantial proportion of patients with mental disorders report frequent use of herbal alternative medicines. Our current understanding of the biology of such remedies suggests that they may have implications for ECT practice.We conducted electronic literature searches using Medline (via PubMed), Cochrane Database of Systematic Reviews, ACP Journal Club, PsychINFO, Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials from their inception to April 2003. The search items were five selected herbal alternative medicines (Ginkgo biloba, ginseng, St. John’s wort, valerian, kava-kava) in combination with the terms “drug interaction,” “adverse effects,” “side effects,” “adverse drug reactions,” “safety,” and “toxicity.” All data were included regardless of whether they were case reports, case series, clinical trials, or reviews.Our literature review revealed several potential effects of herbal alternative medicines upon ECT outcome.The growing use of herbal alternative medicine by patients with psychiatric illness may have implications for ECT practice. Our current knowledge is sparse and incomplete, however, indicating the need for more research.