Suicide after unilateral ECT in a patient previously responsive to bilateral ECT

A 34-year-old schizophrenic committed suicide after his fourth unilateral electroconvulsive treatment. He previously responded successfully to seven bilateral treatments. The authors hypothesize that unilateral ECT may post a greater risk than bilateral ECT for the delusional suicidal patient. The rationale underlying this hypothesis states that the greater temporary disruption in cognition and memory associated with bilateral ECT is actually desirable in suicidal patients although it is an unwanted side effect in nonsuicidal patients. Since energy and mood often improve before delusions, bilateral ECT may neutralize delusions during the time of maximum suicidal risk as patients begin to improve.