Restriction spectrum imaging shows extracellular water shifts drive ECT-related volume changes

Restriction spectrum imaging in depression patients shows ECT causes right amygdala/hippocampus hindered water increase, free water decrease, and volume increase; volume partially resolves but amygdala extracellular changes persist, suggesting glymphatic flow shifts.

• After ECT, right amygdala and hippocampus showed increased hindered water fraction and decreased free water fraction, while intracellular fraction remained stable.
• Volume increases in amygdala and hippocampus partially resolved at 3-month follow-up, but right amygdala extracellular indices persisted.
• Clinical improvement did not correlate with imaging changes, supporting a glymphatic rather than direct symptom mechanism.

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