Serotonin-2 (5-HT-2) receptors in brain were measured using [3H]ketanserin. We examined the effects of amitriptyline, an antidepressant drug, of electroconvulsive shock (ECS) and of drug-induced alterations in presynaptic 5-HT function on [3H]ketanserin binding to 5-HT-2 receptors in rat brain. The importance of intact 5-HT axons to the up-regulation of 5-HT-2 receptors by ECS was also investigated, and an attempt was made to relate the ECS-induced increase in this receptor to changes in 5-HT presynaptic mechanisms. Twelve days of ECS increased the number of 5-HT-2 receptors in frontal cortex. Neither the IC50 nor the Hill coefficient of 5-HT in competing for [3H]ketanserin binding sites was altered by ECS. Repeated injections of amitriptyline reduced the number of 5-HT-2 receptors in frontal cortex. Reserpine, administered daily for 12 days, caused a significant increase in 5-HT-2 receptors, but neither daily injections of p-chlorophenylalanine (PCPA) nor lesions of 5-HT axons with 5,7-dihydroxytryptamine (5,7-DHT) affected 5-HT-2 receptors. However, regulation of 5-HT-2 receptors by ECS was dependent on intact 5-HT axons since ECS could not increase the number of 5-HT-2 receptors in rats previously lesioned with 5,7-DHT. Repeated ECS, however, does not appear to affect either the high-affinity uptake of [3H]5-HT or [3H]imipramine binding, two presynaptic markers of 5-HT neuronal function. 5-HT-2 receptors appear to be under complex control. ECS or drug treatments such as reserpine or amitriptyline, which affect several monoamine neurotransmission systems including 5-HT, can alter 5-HT-2 receptors. While depleting 5-HT alone (5,7-DHT or PCPA) does not alter [3H]ketanserin binding to 5-HT-2 receptors, intact 5-HT axons are necessary for the adaptive up-regulation of the receptor following ECS.