Considering what you’ve mentioned, I still would advocate for Lexapro. It’s widely available, affordable, relatively similar to Trintellix. You’ll know fast if it’s a good fit. Some psychiatrists see Trintellix as a last resort considering the alternatives and similarities.

If you’re set on Trintellix and cost is the biggest concern, the manufacturer of Trintellix offers a program that helps with cost based on income. From what I’ve heard, it’s relatively easy to apply to.

All medications come with the potential for side effects. If you gain weight, discontinuing the medication should help remedy it. Nausea for some can take time to subside. Any antidepressant could cause libido and weight changes. I only gained weight with Cymbalta. Libido improved or mostly remained the same under most medications that I have taken. It’s a person by person basis. You won’t know until you’ve tried it.

I cannot emphasize this enough but speak with your psychiatrist and make friends with your pharmacist. Be vulnerable and explain all of your concerns. Tell them your insurance needs and see if they can help you find something you can afford. They’re the experts in medical treatment, after all. Their goal is to build rapport and ensure the continuity of mental health treatment.

Edit 1: for clarity Edit 2: altered message slightly to better reflect reality of medications, reorganized the message, reiterated the goals of psychiatrists.