Electroconvulsive therapy induces rapid microstructural and macrostructural changes, but microstructural changes are longer-lasting.

Changes in left hippocampus and both insular cortices did not reach statistical significance.

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MD change within GM ROIs (T0 – T1.1), and voxel-wise diffusion changes in the WM skeleton (T0 – T1.1).) Although a lower decrease in the imprinting score of RAVLT seemed to be associated with a larger GM volume increase during the ECT-course (i.e., T0 – T1.1) in multiple clusters, this association just failed to reach significance after accounting for testing multiple brain-behavior associations (minimum p uncorrected = 0.0125, p corrected for multiple cognitive tests = 0.05; Supplementary Fig. 4).

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We did detect borderline significant associations between the imprinting score of RAVLT and anatomical clusters adhering to the functional default mode and salience networks (Supplementary Fig. 4), suggesting that larger volume increases in these regions mitigate the ECT-related cognitive decline.

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