“…We hypothesize that during the course of MDD, when reaching treatment resistance, the lack of DMN deactivation during tasks may lead to compensatory pathological resting-state hypoconnectivity. Despite its efficacy, ECT is often still regarded as a treatment-of-last-resort [ 24 , 25 , 45 , 46 ]. Therefore, even though we had no data to confirm the degree of treatment resistance in our sample, generally, depressed patients receiving ECT show high rates of treatment resistance, which may explain our findings.…”