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Comparison guide · 2026
Two at-home ketamine programs, two different ideas about dosing. One is a daily sub-dissociative microdose that fits inside your day. The other is one or two dissociative-dose sessions a week with a companion in the room. Here is how they compare on cost, care, safety and the evidence each can show.
Published by Joyous. Discreet Ketamine figures come from Discreet Ketamine's own website, observed November 1, 2026, and are linked in the references. Joyous figures are Joyous patient outcomes data and published pricing. No head-to-head study of the two programs exists.
The quick answer
Joyous is an at-home provider of personalized ketamine microdose therapy for depression, anxiety and PTSD, built around a provider-directed daily protocol: a licensed clinician approves treatment and sets the starting dose by video; AI-powered daily check-ins track response and surface what needs clinical attention; the dose is adjusted through treatment with every change approved by the clinician. Sold as a monthly subscription including medication, in 34 states.
Discreet Ketamine is a single-physician telehealth practice (Benjamin Soffer, DO, board-certified in internal medicine) that prescribes therapeutic-dose sublingual ketamine for one to two at-home sessions a week, with a sober adult companion required at each session, in Florida, New Jersey and California. Plans cover physician visits; medication is billed separately by a compounding pharmacy.46
A daily sub-dissociative (low) dose you take inside your normal day, personalized to you. 15 mg to 120 mg: your minimal effective dose, found through daily check-ins and adjusted throughout.
1–2 dissociative-dose sessions a week that take you out of your day; 200 mg tablets, 100–400 mg range.6
$129/month with a three-month commitment or $159/month with none. Medication included.
$250/month (1-month plan) to $183/month (12-month), plus medication (~$50–$150/month) and shipping ($20–$45 per order). Realistic first month in FL/NJ: ≈ $345–$445.6
A licensed clinician available on demand by video, daily check-ins, and every dose change clinician-approved.
One physician for every patient; two 30-minute video visits a month, with email and an app between them.6
A troche a day and a check-in. No companion, no fasting, no lost day.
For every session: a sober adult present, a 6-hour fast, no driving until the next day.6
The largest ketamine therapy provider in the world: 100,000+ patients treated.
"Hundreds of patients treated since 2023."6
Real-world outcomes data from 66,727 patients: 86% response on depression, 87% on anxiety, within six weeks.
No patient outcomes data published as of November 2026; cites intravenous studies that tested neither at-home model.4
34 states.
Florida, New Jersey, California. You must be in-state for treatment.6
Side by side
| Feature | Joyous | Discreet Ketamine |
|---|---|---|
| Model | Daily microdose protocol | 1–2 sessions/week |
| Dose experience | Sub-dissociative | Dissociative ("therapeutic dose") |
| Medication format | Buccal troche | 200 mg RDT (FL/NJ); troche/tablet (CA) |
| Starting dose | 15 mg, titrated | Physician-set, 100–400 mg range |
| Who prescribes | Licensed clinician, by video | One physician (DO) |
| Ongoing oversight | Daily check-ins; clinician on demand by video | 2 video visits/month |
| Companion required | No | Yes, every session |
| Fasting required | No | Yes, 6 hours |
| Dissociation reported | 5% week 1 → 3% week 6 † | Expected, by design |
| States | 34 | 3 (FL, NJ, CA) |
| Assessment | Free | Paid; refunded if you don't qualify |
| Monthly price | $129 (3-mo) / $159 | $250 (1-mo) → $183 (12-mo) |
| Medication included | Yes | No (~$50–$150/mo extra) |
| Shipping | Included | $20–$45 per order |
| Support materials | Psychotherapist-designed courses, meditations | None; therapy recommended |
| Patients treated | 100,000+ | "Hundreds" since 2023 |
| Published outcomes data | 66,727 patients | None published |
| Trustpilot | 4.7 · 2,000+ reviews | No profile found |
| Google reviews | 4.6 · 1,000+ | 5.0 · 26–27 (self-reported) |
† Joyous: effects are subtle and last minutes during the session, self-reported in daily check-ins. Discreet Ketamine figures from discreetketamine.com, observed Nov 1, 2026.6 "No profile found": none found on Trustpilot on Nov 1, 2026.8
Dosing protocol
Both programs prescribe the same medication, ketamine, for at-home use. The difference is how much you take at once and how often.
A note on "microdose." Joyous uses the word for the category: a low daily peak dose. It is not a claim about total exposure; seven daily doses can add up to a comparable weekly amount. What is different is the peak. Joyous doses are designed not to produce a high.
The evidence
Discreet's comparison page says daily low-dose protocols "have less robust clinical evidence," and cites three studies.4 Those studies tested intravenous ketamine in clinical settings.123 None tested at-home sublingual sessions and none tested a daily protocol. They are evidence for ketamine, not for either at-home model.
Patients who started with moderate-or-worse symptoms · six weeks · self-reported PHQ-9/GAD-7 scores · individual results vary.
That is the honest state of the evidence: both are at-home ketamine; one has published what happened to its patients.
Neither program is right for everyone. Both screen out psychosis, active mania or bipolar I, uncontrolled high blood pressure, pregnancy and active substance use disorder; Joyous also screens for seizure history and stroke or brain-injury history.
Cost
Joyous
$129/month
with a three-month commitment, or $159/month with none, dropping to $129 after three months
Discreet Ketamine
$250/month
1-month plan, 2 physician visits. $650 for 3 months, $1,200 for 6, $2,200 for 12 — the plan buys visits only6
Discreet figures from discreetketamine.com, observed Nov 1, 2026; Discreet's own comparison footnote puts medication at $75–$150 a month. Discreet does not publish an all-in number; the total is arithmetic from their published figures. HSA/FSA eligible; neither program is covered by insurance.6
Discreet's roundup calls Joyous the "cheapest legitimate option."5 We'd put it differently: Joyous includes the medication, the check-ins and the clinician in one price.
Clinical oversight
Discreet's comparison page describes Joyous as "text-based check-ins and asynchronous communication."4 Here is what the Joyous protocol actually is.
Both models have a real clinician in charge. The difference is cadence: Joyous reviews daily data continuously; Discreet reviews you at scheduled visits.
Safety and side effects
Self-reported in daily check-ins.
Ketamine is an FDA-approved medication, prescribed off-label for mental health conditions by both programs. Compounded ketamine is not FDA-approved for depression or anxiety.
Reviews
Not every review is five stars. Daily check-ins and medication monitoring are the price of a daily protocol; some patients find them a hassle.
For
Against
For
Against
Ketamine is FDA approved but prescribed off-label for anxiety and depression. Side effects can occur; your clinician will review risks with you. Joyous is not for emergencies.
Joyous is $129 a month with a three-month commitment or $159 a month with none, medication included. Discreet Ketamine's physician plan is $250 for one month, $650 for three, $1,200 for six or $2,200 for twelve, and medication (about $50–$150 a month) and shipping ($20–$45 per order in FL/NJ) are billed separately. A realistic first month at Discreet in Florida or New Jersey is roughly $345–$445.
Discreet Ketamine requires a sober adult to be present for every session. Joyous does not: the daily dose is sub-dissociative by design, so you take it on your own as part of your day. Joyous patients report dissociation in about 5% of cases in week one, falling to 3% by week six; at this dose, effects are subtle and last minutes during the session.
Joyous patients who started with moderate-or-worse depression saw their score cut in half in a median of 16 days, with results continuing to build; the median to the remission range was 48 days. Discreet Ketamine has not published time-to-response data, so no comparison is possible.
Yes. Every Joyous patient meets a licensed clinician by video, who assesses symptoms and prescribes the treatment protocol before medication ships. After that, your clinician is available on demand by video, AI-powered daily check-ins track your response, and your clinician adjusts your dose as needed; no change happens without clinician approval.
There is no head-to-head study. What exists: Joyous has published real-world outcomes data from 66,727 patients, with 86% response and 54% reaching the remission range on depression, and 87% and 59% on anxiety, over six weeks among patients who started with moderate-or-worse symptoms. Discreet Ketamine has not published patient outcomes. The intravenous studies Discreet cites did not test either at-home model.
Yes, if you live in one of the 34 states Joyous serves and you qualify after the online assessment and clinician video visit. Tell your Joyous clinician about your current ketamine treatment; your protocol starts at the low end and is adjusted to you.
Joyous is available in 34 states. Discreet Ketamine is licensed in Florida, New Jersey and California only, and you must be physically in-state for treatment.
Neither includes talk therapy sessions. Discreet Ketamine recommends pairing sessions with your own therapist. Joyous includes support materials designed by psychotherapists, guided courses and meditations to help process underlying emotions, alongside the medication; 38% of Joyous patients were in talk therapy at the same time.
