Sesame vs. Better U (2026): Standard Psychiatry or At-Home Ketamine?

Sesame and Better U are both self-pay, but they offer very different treatment. Sesame is a marketplace for therapy and psychiatry, where clinicians prescribe standard, non-controlled medications. Better U is an at-home ketamine program for adults whose symptoms haven’t improved with standard treatment.

The short answer

• Start with Sesame if you haven’t yet tried standard treatment.
• Consider Better U only if you’re an adult whose symptoms haven’t improved after standard treatment, and after talking it through with a clinician.

How they compare

A note on ketamine

Generic ketamine is FDA-approved as an anesthetic; prescribing it for depression or anxiety is off-label. The related drug esketamine (Spravato) is FDA-approved for treatment-resistant depression, but only under supervision in a certified clinic. At-home ketamine can raise blood pressure and cause dissociation, long-term evidence is still limited, and in 2023 the FDA warned about risks of compounded ketamine used at home for psychiatric conditions. Better U’s screening excludes many people for safety reasons — see our Better U review for the full list.

Using them together

If you do go on to ketamine treatment, keep a regular therapist and prescriber involved. Sesame can provide ongoing therapy or standard medication management alongside it.

A marketplace for standard care versus a ketamine program

Sesame lets you book therapists, psychiatric clinicians and primary care providers at upfront cash prices, and its providers can prescribe common non-controlled mental health medicines such as antidepressants. Better U is a specialized program that prescribes oral ketamine for home use, off-label, with a medical screening, preparation and integration coaching. Both are self-pay, but they sit at different points in treatment: standard care first, ketamine considered when standard treatments haven’t helped. See our reviews of Sesame and Better U.

Cost scenarios

Prices come from each provider’s published pricing as summarized in our reviews.

• Sesame: mental health visits from about $34, psychiatrist appointments averaging about $132 for 45 minutes, and a Mental Health Rx subscription at $79 a month. Medication is paid separately.
• Better U: packages from $500 for five sessions (about $100 each) up to $2,076 for 27 sessions with six integration sessions (about $76 each). Insurance doesn’t cover it; third-party financing is available.

A few months of medication care on Sesame would cost a few hundred dollars, while a ketamine program is generally over $500, so it makes sense to be sure standard options have had a fair trial.

Prescribing and clinical scope

Sesame providers do not prescribe controlled substances, which rules out stimulants and benzodiazepines, and ketamine is not offered. Sesame lists antidepressants, non-controlled anti-anxiety medicines, some mood stabilizers and antipsychotics, and non-stimulant ADHD medication among the medicines its providers commonly prescribe, at the provider’s discretion. Better U’s oral ketamine is used off-label for depression, anxiety or PTSD, and the program requires screening and a safety protocol.

Safety and eligibility

Better U excludes many people, including those with psychosis, active substance use disorders, uncontrolled high blood pressure, heart disease, seizures or a history of brain bleeds, and people who are pregnant or planning pregnancy. It requires a blood pressure monitor and an adult peer supporter during sessions and is available in about 30 states. Ketamine can raise blood pressure and cause dissociation, and long-term evidence for at-home oral ketamine is still limited. Sesame is a marketplace, so the credentials and approach vary by clinician; check each profile, and note that psychiatrists aren’t available in every state.

Choosing by situation

• You haven’t tried treatment, or you want to start with therapy or a common antidepressant: Sesame’s cheaper, flexible visits fit. Compare it with PlushCare if you want insurance billing.
• You’ve tried multiple standard treatments and want to discuss ketamine: Better U is designed for this. Speak first with a clinician who knows your history, and ask about in-person options such as Spravato.
• You’re in crisis: call or text 988 in the US or call 911. See Get Help Now.

Coordinating care across both

Some people see a Sesame therapist or prescriber while pursuing ketamine, which is sensible because ketamine programs are best paired with ongoing therapy. Make sure every clinician knows about all medicines you take.

Questions to ask before you choose

1. How long and how thoroughly have I tried standard treatment?
2. What is the total cost of each route over three months?
3. Do I meet Better U’s screening and state availability?
4. Who will coordinate my care?
5. What is the plan if I feel worse?

See our guides to online depression treatment and antidepressants for more.

Our verdict

For most people, Sesame is the more appropriate and affordable first step. Better U is a specialized option for treatment-resistant symptoms, to discuss carefully with a clinician.

If you have thoughts of suicide, call or text 988 in the US or call 911 — see Get Help Now.