Objectives: To determine the clinical use of ECT in treatment of different psychiatric disorders at KKUH. Design: A retrospective clinical study of all inpatients given ECT over a ten years period. Setting: Psychiatric Unit at King Khalid University Hospital, (KKUH). Subjects: One hundred and twenty seven inpatients, 51 males and 76 females given ECT. Measures: Data collection form for demographic characteristics and clinical parameters and global improvement scale. Results: Usage ratios was 5.0% and female to male ratio 1.5:1 inspite nearly equal total admissions for both sexes. ECT was used primarily in more than 75% of cases for affective disorder and in 68.5% of cases, the indication was no response to medication. Seventy five percent of cases showed good or marked improvement, but 79% of non-responders were schizophrenic. The common age group given ECT was 19-30 years. Interpretations: This study shows a shift in clinical use over time in developing countries of ECT from schizophrenia to be mainly used for affective disorders. More females are given ECT could be due to cultural emphasis on stigma in psychiatrically ill females. Conclusion: Our results comply with recommendations set by the Royal College of Psychiatrists and the American Psychiatric Association for ECT clinical use. ECT is a valuable and safe treatment modality in psychiatry that should be mainly used in affective disorders and selectively in schizophrenia.