The efficacy of electroconvulsive therapy (ECT) in depression is dependent on the duration of seizure. Over a course of ECT, progressive reduction in the duration of the induced seizure is common. Caffeine pretreatment is reported to prolong seizure activity in patients experiencing inadequate seizure activity although maximal electrical stimulus for ECT is applied. The side effects of caffeine are anxiety, psychomotor agitation, prolonged seizures, enhanced hemodynamic changes and arrythmias. Caffeine is generally well tolerated by most patients, but it should be used with caution for those medically fragile patients, i.e., with preexisting cardiac disease. We describe here a case of anesthesia for ECT with caffeine augmentation. A 61-year-old man was diagnosed of major depression. Caffeine pretreatment with ECT was scheduled after antidepressants and 3 ECTs failed. Hypertension and tachyarrythmia were treated with esmolol.