Written by Samrawit Mersha (PMHNP-BC), and clinically reviewed by Kartiki Churi, MD, MBA, FAPA, Chief Medical Officer, Axis Integrated Mental Health.
Lexapro often feels like it is not working in the fall because shorter days change how your brain handles serotonin; the same chemical Lexapro works on. Some people also build tolerance to SSRIs over time. If you have tried two or more antidepressants and still feel stuck, Spravato treatment works on a different brain system and is FDA-approved for treatment-resistant depression.
Often, it isn’t even a pill. It’s the season. This blog explains the clinical reasons Lexapro can slip in fall, how to tell a seasonal dip from tolerance, and where Spravato fits when your options feel used up.
Why does Lexapro stop working in the fall?
Lexapro can seem to stop working in the fall because your brain makes more serotonin transporters when the days get shorter. Lexapro works by blocking those transporters. When there are more of them, the same dose has more work to do.
Lexapro (escitalopram) is an SSRI, or selective serotonin reuptake inhibitor. It blocks the serotonin transporter, a protein that pulls serotonin out of the space between brain cells. Less clearing means more serotonin stays available to steady your mood.
Here’s the fall problem. In a brain-scan study of 88 healthy adults, people scanned in fall and winter had higher serotonin transporter levels in every brain region measured than people scanned in spring and summer. The fewer hours of sunlight, the higher the levels.
Read More: Emotional Blunting from Antidepressants: What to Do
Think of it like a sink with several drains. Lexapro plugs some of them. In fall, your brain opens more drains. The plug is the same, but more water is leaving.
Other fall changes stack on top. Less morning light shifts your body clock. Sleep runs longer, energy drops, and you spend less time outside. These are often the signs that show up before the mood does.
Why do antidepressants fail in fall for some people and not others?
Antidepressants are more likely to slip in fall if your depression has a seasonal pattern, if you live far from the equator, or if your medication only ever partly worked. Colorado checks two of those boxes for many people.
Seasonal depression, called major depressive disorder with seasonal pattern, is more common farther from the equator. A review of 20 population studies found rates as high as 9.7%, with higher rates at northern latitudes. The National Institute of Mental Health notes that seasonal symptoms usually last about 4 to 5 months.
Sunshine doesn’t fully protect you, either. Clocks fall back on Sunday, November 1, 2026, and Front Range sunsets land before 5 p.m. for much of December. That’s why 300 days of sun doesn’t protect you from seasonal depression in Colorado.
Partial response matters, too. If Lexapro took the edge off but you never felt fully well, a seasonal dip can push you back under the line. Our broader guide on why you may still be depressed on antidepressants in winter covers this in depth.
Is Lexapro not working, or is it something else?
There are three common reasons a Lexapro antidepressant feels weaker: a seasonal dip, tolerance that builds over months or years, or a trial that was never long or strong enough. Each one has a different fix, so naming it matters.
| What you notice | What it may point to | What to ask your provider |
|---|---|---|
| Mood drops every fall and lifts every spring | Seasonal pattern | Should we plan a fall dose change or add light therapy? |
| It worked for a year or more, then faded with no seasonal pattern | Tolerance (“poop-out”) | Is it time to switch or add something? |
| You never felt fully better | Partial response or low dose | Have I had a fair trial at a full dose? |
| You feel flat or numb, not sad | Emotional blunting | Could the medication be causing this? |
| Bursts of high energy and little sleep | Possible bipolar disorder | Should I be screened? |
Tolerance is real and well documented. Across published trials, depression came back in 9% to 57% of people taking a steady antidepressant dose. The range is wide because studies measured it in different ways and over different lengths of time.
One safety note: don’t stop Lexapro on your own. Stopping suddenly can cause dizziness, irritability, flu-like feelings, and “brain zaps.” Any change should be planned with your prescriber or through medication management.
What is the difference between SSRIs and Spravato?
SSRIs like Lexapro slowly raise serotonin and usually take several weeks to work. Spravato (esketamine) is a nasal spray that acts on glutamate, the brain’s main “go” signal, and often works within days. Because it uses a different pathway, it can help when serotonin medicines have stalled.
| Feature | Lexapro (escitalopram) | Spravato (esketamine) |
|---|---|---|
| How it works | Blocks serotonin transporters | Blocks NMDA receptors, which boosts glutamate signaling and new brain connections |
| How you take it | A pill at home, every day | A nasal spray you use yourself in a certified clinic |
| How fast it works | Usually several weeks | Often within days |
| Who it’s for | A common first choice for depression and anxiety | Adults who have tried at least two antidepressants |
| Fall effect | Works on the system that shifts in fall | Works on a separate system |
| Trade-offs | Side effects like sexual changes or emotional numbness | About 2 hours of monitoring, no driving until the next day, twice-weekly visits at first |
| Insurance | Usually covered as a generic | Covered by most major plans with prior authorization, including Colorado Medicaid |
The research is solid. In a 2023 study in the New England Journal of Medicine, 27.1% of adults with treatment-resistant depression reached remission at 8 weeks on Spravato plus an SSRI or SNRI.
Can you take Spravato and Lexapro together?
Yes. Spravato is often used along with an oral antidepressant like Lexapro. In January 2025, the FDA also approved Spravato on its own for adults with treatment-resistant depression, so your provider can talk with you about either path.
That matters if you’re tired of side effects. Your psychiatric provider will look at your history and decide with you whether to keep Lexapro, adjust it, or use Spravato alone.
Who is a good candidate for Spravato treatment?
Spravato is for adults 18 and older with depression who have tried at least two antidepressants without enough relief. It may not be the right fit if you have active substance use, a history of psychosis such as schizophrenia, are pregnant, or have certain blood vessel conditions or uncontrolled high blood pressure.
At Axis, patients need to be sober for at least six months before starting Spravato. We also check for conditions that can look like depression, such as undiagnosed ADHD, bipolar disorder, or PTSD. When those are missed, Spravato may not work as well. If Spravato isn’t the right fit, Deep TMS is another option that uses no medication at all.
When should you start Spravato if Lexapro fades every fall?
If your mood dips every fall, late October or early November is the best time to get evaluated. That timing lets insurance approval and the twice-weekly start phase finish before the darkest weeks of December and January.
Here’s what a Colorado fall timeline can look like:
- Late October: Intake with a psychiatric provider. New patients are usually seen within 7 days. Bring a list of every antidepressant you’ve tried, the dose, and how long you took it.
- Early November: Our in-house team handles prior authorization. Treatment can start 2 to 5 days after approval.
- Mid-November to mid-December: Twice-weekly sessions for four weeks.
- Mid-December to mid-January: Weekly sessions through the shortest days of the year, including the December 21 solstice.
- Late January on: Sessions spaced out based on how you’re doing.
Insurance timing varies, so this is an example, not a promise. Compare it with trying a new pill, which can take several weeks just to judge. Waiting until January can mean spending most of winter in the trial period.
Where can you get depression treatment in Denver, DTC, Boulder, and Westminster?
Axis Integrated Mental Health offers Spravato, Deep TMS, psychiatry, and therapy at four Colorado clinics, plus statewide telehealth. Every clinic is open Monday through Saturday.
- Depression treatment in Denver: 1444 S Potomac St, Suite 220, Aurora
- Depression treatment in DTC: 6950 E Belleview Ave, Suite 300, Denver (our largest clinic)
- Depression treatment in Boulder: 400 S McCaslin Blvd, Suite 111, Louisville
- Depression treatment in Westminster: 8758 Wolff Ct, Suite 205, Westminster
Axis is a three-time Best of Mile High winner and Boulder County’s Gold winner for Best Mental Health Clinic.
What should you do next if Lexapro is fading this fall?
Start with small, safe steps. You don’t have to decide on a new treatment today.
- Keep taking Lexapro as prescribed while you sort this out.
- Track your mood, sleep, and energy once a week.
- Write down every antidepressant you’ve tried, with doses and dates.
- If you’ve tried two or more, ask about alternative depression treatments like Spravato and Deep TMS.
- Check your coverage for free or estimate costs with our Spravato cost calculator.
Ready to talk it through? Schedule online or call or text 720-400-7025.
Frequently asked questions
Jump to: Lexapro and fall | Spravato sessions | Cost and coverage
Lexapro and fall
What does Lexapro “poop-out” feel like?
Lexapro poop-out feels like your old depression is slowly coming back even though you take your dose every day. Low mood, poor sleep, low energy, or a loss of interest creep in over weeks, often after months or years of feeling better. If it happens every fall, it may be a seasonal pattern instead. Our guide on why you may still be depressed on antidepressants in winter helps you sort out which one you have.
Can I keep my Lexapro antidepressant from fading next fall?
You may be able to lower the chance. The National Institute of Mental Health notes that starting seasonal depression treatment before fall may help prevent or ease symptoms. Ask your provider in late summer about a fall plan, such as light therapy or a planned dose review. Start with our winter home checklist for seasonal depression.
Spravato sessions
Can I go to work after a Spravato treatment session?
You can’t drive after a session, and most people rest for the remainder of that day. You’ll stay in the clinic for about two hours of monitoring, and you can’t drive until the next day after a full night’s sleep. Many people book sessions in the afternoon and return to work the next morning. See our new patient guide for tips on planning around your schedule.
What happens if Spravato treatment doesn’t work for me?
If Spravato doesn’t help, Deep TMS is usually the next option to explore. Your provider will first check for things that can block results, like undiagnosed ADHD, bipolar disorder, PTSD, or substance use. Deep TMS uses magnetic pulses instead of medication. Learn more about Deep TMS for depression.
Cost and coverage
How do I get Spravato treatment covered by insurance in Colorado?
Most major plans cover Spravato for adults when records show you’ve tried at least two antidepressants. Your clinic sends a prior authorization to your insurer with that history. In Colorado, Medicaid also covers Spravato for eligible adults, though it isn’t covered for anyone under 18. At Axis, our in-house team handles the paperwork for you. Check your coverage for free.
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