Allan Scott is a consultant psychiatrist in general adult psychiatry and an honorary senior lecturer in the Andrew Duncan Clinic at the Royal Edinburgh Hospital (Morningside Terrace, Edinburgh EH10 5HF, UK. Email: Fiona.Morrison{at}lpct.scot.nhs.uk). He was a member of the UK ECT Review Group, which undertook the systematic review of clinical trials in ECT.
Electroconvulsive therapy (ECT) remains an important treatment option for severe depressive illness, but it can have side-effects, including permanent gaps in memory. Where minimising the intellectual side-effects of treatment has priority, then treatment to only one side of the head (unilateral ECT) is preferable; where the speed of clinical improvement is paramount, then bilateral ECT may be preferred. The choice of how ECT is administered should, where possible, be part of the process of informed consent.