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The authors describe the clinical case of a 69-year-old patient with psychotic depression and exuberant physical symptoms. Because of the significant physical symptoms and the age group, a medical assessment was made that allowed organic disease to be excluded. Despite the psychopharmacological therapy, the patient did not present any significant clinical improvement. Electroconvulsive therapy was conducted in the acute phase, and by relapse under anti-depressive therapy, also on-going and for maintenance. A total remission of the clinical and functional situation was achieved and the patient restarted professional activity. The report of this case is justified by its peculiar presentation and the benefit that was achieved with electroconvulsive therapy (acute and continuation/maintenance), associated with the psychopharmacological therapy that ensured a significant clinical remission.