Discussed are the use of unilateral ECT & questions of how the clinician is to balance the sharply reduced cognitive side effects of unilateral ECT with a therapeutic advantage for bilateral ECT in selecting treatment for a depressed patient. It is suggested that treatment should be initiated with nondominant unilateral ECT except for patients who are psychotic, clearly suicidal, severly agitated, or catatonic. 13 refs. (NBB)