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Serotonin syndrome Serotonin syndrome (or hyperserotonemia) is a hyperserotonergic state, that is an excess of 5-HT (serotonin) in the central nervous system. It is usually associated with high doses of serotonergic drugs, when combinations of serotonergic agents are used together, or when antidepressants are changed without an adequate washout period between drugs. Less frequently it can also be caused by moderate dosage of a single serotonergeric drug, or in combination with non-serotonergeric drugs such as oxycodone, erythromycin, or St. John's Wort. Serotonin syndrome is rare, but it is a serious, potentially life-threatening medical condition. However there is no lab test for the condition, so diagnosis is by symptom observation. It may go unrecognized because it is often mistaken for a viral illness, anxiety, neurological disorder or worsening psychiatric condition.Clinicians must differentiate between serotonin syndrome and Neuroleptic malignant syndrome, which has similar symptoms. Patients taking serotonergic drugs and who have sudden onset of the below symptoms should immediately seek medical care. Symptoms may be classed into three groups:     * cognitive effects: mental confusion, hypomania, agitation, headache, coma     * autonomic effects: shivering, sweating, fever, hypertension, tachycardia, nausea, diarrhea     * somatic effects: myoclonus/clonus (muscle twitching), hyperreflexia, tremor Insomnia, sleep disruption, and unrefreshing sleep are also reported symptoms. Drugs which may contribute Class     Drugs antidepressants     MAOIs, TCAs, SSRIs, mirtazapine, venlafaxine, St John's Wort opioids     tramadol, pethidine, CNS stimulants     phentermine, diethylpropion, amphetamines, sibutramine 5-HT1 agonists     triptans illicit drugs     methylenedioxymethamphetamine (MDMA), lysergic acid diethylamide (LSD), cocaine others     selegiline, tryptophan, buspirone, lithium, linezolid, dextromethorphan, 5-HTP Reference: Rossi, 2005 The combination of MAOIs and other serotonin agonists or precursors poses a particularly severe risk of a life-threatening serotonin syndrome episode. Many MAOIs inhibit monoamine oxidase irreversibly, so that the enzyme cannot function until it has been replaced by the body, which can take at least two weeks. A dangerous serotonin syndrome reaction can occur unless serotonin agonists and even serotonin precursors such as foods containing tryptophan are strictly avoided until the monoamine oxidase has been replaced. Treatment There is no antidote to the conditions itself, but emergency medical clinicians often administer cyproheptadine or methysergide to control the symptoms.  Doing so is important as the symptoms can in severe cases be potentially life threatening.