Patient reports of systemic side effects and cognitive impairment were obtained the afternoon of each treatment during the electroconvulsive therapy (ECT) course. Side effects were grouped a priori as reflecting physical complaints, perceived cognitive impairment, and as mood-related. Patients randomly assigned to bilateral ECT reported more cognitive impairment than patients who received right unilateral ECT. There were indications that the unilateral ECT group had greater physical/somatic complaints. Patients who responded to ECT differed from nonresponders only on the more explicitly mood-related items. Generally, the findings supported the desirability of extending studies of patient reports of ECT adverse effects to include subjective systemic side effects in addition to subjective cognitive impairment.