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Background: The SPECT (Single Photon Emission Computed Tomography), an advance in medical imaging, allows the measure of cerebral blood flow and could be of interest in studying mental disorders. Pseudodementia or cognitive disorders which can be observed in depressed patients can be diagnosed for both the history and the course of the disorder. Additional brain imaging can give further indications. Case Report: We describe a case report of depressive pseudodementia, emphasizing two questions: firstly, the usefulness of 99m-Tc-HMPAO brain single photon emission computed tomography (SPECT) as diagnostic proof, and secondly, the usefulness and tolerability of combined electroconvulsive therapy and antidepressant agent treatment.Conclusions: We conclude the important usefulness of neuroimaging as a complementary diagnostic technique in depressive pseudodementia, especially taking into account the lack of other diagnostic proofs or specific clinical parameters. We found no differences of seizure length and side effects, especially cardiac effects (ECG, heart rate, and blood pressure) in an old patient treated with concurrent ECT and venlafaxine. However, safety and efficacy of combined antidepressant agent and ECT requires further research.