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Introduction Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity in the central nervous system. It is characterized by mental status changes (eg, confusion, agitation, lethargy, coma), autonomic instability (eg, hyperthermia, tachycardia, diaphoresis, nausea, vomiting, diarrhea, dilated pupils), and neuromuscular hyperactivity (eg, myoclonus, hyperreflexia, rigidity, trismus). Serotonin syndrome classically occurs in patients receiving two or more serotonergic drugs, but it can occur with monotherapy. We report a case of a 20-year-old man who developed serotonin syndrome resulting from overdose of Escitolapram with concomitant use of cocaine. It is a very important area in medicine as serotonin syndrome should be suspected especially in drug abusers who are being treated with psychotropic agents for mental illnesses.