Out on PubMed yesterday is this editorial by noted ECT researcher, Harold Sackeim:

 The Impact of Electroconvulsive Therapy on Brain Grey Matter Volume: What Does It Mean?
Sackeim HA.Brain Stimul. 2020 May 19:S1935-861X(20)30093-0. doi: 10.1016/j.brs.2020.04.014. Online ahead of print.PMID: 32442625 
A link to the pre-print is here.
This is an erudite, theoretical piece, prompted by the neuroimaging studies of the GEMRIC
collaboration. It is certainly worth reading in it's entirety, but I can summarize for you, if you prefer: we do not yet understand the pathophysiology of the observed brain structural changes seen after ECT, nor do we understand their implications for efficacy or adverse effects. Dr. Sackeim discuses how we will need to disentangle effects from seizure, electrode placement, stimulus package and charge density in the brain, all the while taking into account the time course of ECT's actions (sometimes very rapid).
He concludes:
As Seymour Kety once famously noted, ECT results in hundreds of consistent effects on brain chemistry and physiology, making it almost impossible to sort out which effects are essential to efficacy from all that are epiphonema [88]. However, we are just at the start of widening our understanding of the meaning of these volumetric effects, inspired by the findings of the GEMRIC multinational collaboration.
Please see also blog post of 4/15/2020

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