Predicting memory problems in older depressed patients receiving electroconvulsive therapy (ECT) is difficult. In this study, hippocampal volume and acute memory outcomes were examined in 15 patients following an index course of ECT. Smaller hippocampal volume was associated with poorer ECT-related memory outcomes. These results add to a growing literature on memory, ECT, and the hippocampus. Although the findings are significant, the sample size in the study is small, so future studies with more complex modeling of key variables that may influence memory are warranted.