A Brief History of Ketamine: From Battlefield Medicine to Club Culture and Mental Health Treatment

Few drugs have travelled quite as unusual a path as ketamine. Developed as an anaesthetic in the 1960s, it went on to become a valuable medicine in war zones and hospitals, a familiar substance in dance music culture, and more recently, the subject of renewed interest as a treatment for depression.

Its history is one of changing uses, unexpected discoveries and a growing understanding of both its benefits and its potential harms.

The 1960s: The search for a better anaesthetic

Ketamine's story begins in 1962, when American chemist Calvin Stevens synthesised the substance while working with the pharmaceutical company Parke-Davis.

Researchers were looking for an alternative to an earlier anaesthetic called phencyclidine (PCP). Although PCP could produce effective anaesthesia, it sometimes caused prolonged confusion, agitation and disturbing psychological experiences. Ketamine offered something different.

It could produce anaesthesia and powerful pain relief while generally preserving breathing and certain protective reflexes better than many traditional anaesthetics.

Early human studies began in 1964, and in 1970 ketamine was approved for medical use in the United States under the brand name Ketalar.

One of its most unusual characteristics was the way it affected consciousness. People could appear awake, sometimes with their eyes open, while remaining largely disconnected from their surroundings.

This became known as dissociative anaesthesia, a term that remains closely associated with ketamine today (Le Daré et al., 2021).

The 1970s: From hospitals to the battlefield

Ketamine soon established a valuable role in emergency medicine.

During the Vietnam War, it was used to treat injured American military personnel. Its ability to provide anaesthesia and pain relief, without requiring the same level of equipment as some other approaches, made it particularly useful in difficult medical environments. Its usefulness extended beyond military settings.

Ketamine became established in emergency departments, operating theatres and veterinary medicine. It was particularly valuable where rapid pain relief or anaesthesia was required.

Over time, it also became an important medicine in countries where access to advanced anaesthetic equipment was limited. Indeed, ketamine remains on the World Health Organization's Model List of Essential Medicines, reflecting its continuing importance in healthcare (WHO, 2025).

This is an important part of ketamine's history. Despite concerns about non-medical use, it remains a valuable and sometimes lifesaving medicine.

The 1980s and 1990s: Ketamine enters recreational culture

Alongside its medical uses, ketamine began attracting interest for a very different reason: its unusual effects on perception and consciousness.

Recreational use had emerged in the United States during the 1970s, but ketamine became increasingly associated with dance music and club culture during the 1980s and 1990s.

Often known as Special K, it developed a reputation for producing experiences quite different from those associated with alcohol, stimulants or traditional hallucinogens. People described feelings of floating, detachment from their bodies, changes in their perception of time and space, and sometimes profound alterations in their sense of reality.

At higher doses, these effects could become overwhelming. The term K-hole emerged to describe particularly intense experiences of dissociation, sometimes involving a profound loss of connection with ordinary surroundings.

In Britain, ketamine became increasingly visible within rave, festival and nightclub settings during the 1990s.

Its place in recreational culture was unusual. Unlike stimulants, which were often used for energy and sociability, ketamine's appeal centred on detachment, altered perception and sometimes deeply introspective experiences.

However, these same effects could create considerable risks, including confusion, falls, injuries and vulnerability while intoxicated.

The 2000s: A growing awareness of harm

As recreational ketamine use became more established, concerns about its longer-term consequences began to emerge. Of particular importance was the growing recognition that repeated use could cause serious bladder problems.

People using ketamine frequently were presenting with painful urination, urgency, frequent trips to the toilet and, in more severe cases, significant damage to the bladder and kidneys. Research also began identifying problems involving memory, concentration, abdominal pain and psychological wellbeing.

These findings challenged the assumption that ketamine was relatively harmless simply because it was a recognised medical anaesthetic.

In the UK, ketamine became a Class C controlled drug in January 2006. Following further concerns about its harms, it was reclassified as Class B in June 2014.

The changing legal position reflected increasing concern about the consequences of frequent non-medical use, particularly among younger people (ACMD, 2013; ACMD, 2026).

A surprising development: Ketamine and depression

While concerns about recreational use were growing, researchers were also investigating another unexpected possibility. Could ketamine help people experiencing severe depression?

In 2000, researchers at Yale University published a small study suggesting that ketamine could produce relatively rapid improvements in depressive symptoms (Berman et al., 2000).

This was an important finding because most conventional antidepressant medications take considerably longer to produce noticeable benefits.

The discovery stimulated substantial research into ketamine's effects on depression and its potential use when other treatments had been unsuccessful.

In 2019, a nasal spray containing esketamine, a form of ketamine, received regulatory approval in the United States and Europe for certain cases of treatment-resistant depression.

However, approval does not mean that these treatments are suitable or routinely available for everyone. In England, NICE did not recommend esketamine nasal spray for routine NHS treatment of treatment-resistant depression in its 2022 appraisal.

The distinction between controlled medical treatment and repeated recreational use remains important. Clinical treatments involve carefully selected patients, monitored doses and professional supervision. The fact that ketamine has therapeutic potential does not remove the risks associated with frequent, uncontrolled use.

Ketamine today: An unusual position

More than sixty years after it was first developed, ketamine occupies an extraordinary position. It remains an important anaesthetic, particularly in emergency medicine and settings where resources are limited. It is also the subject of continuing research into depression and other mental health conditions.

At the same time, rising levels of non-medical use in the UK have brought renewed attention to its potential for serious physical and psychological harm.

In January 2026, the Advisory Council on the Misuse of Drugs published an updated review of ketamine use and harms. It recommended retaining ketamine's Class B classification while strengthening efforts to recognise, prevent and respond to ketamine-related problems (ACMD, 2026).

These different identities can sometimes create confusion.The same substance can be an essential medicine in one setting, a treatment under investigation in another, and a source of significant harm when used repeatedly outside medical supervision. Understanding ketamine therefore requires more than viewing it simply as either a medicine or a recreational drug.

Its history demonstrates how the uses of a substance can change over time, while our understanding of its benefits and risks continues to develop.

For practitioners, researchers and people affected by ketamine use, that history provides an important reminder: recognising both its medical value and its potential harms is essential to developing informed, proportionate responses.

References

Advisory Council on the Misuse of Drugs (ACMD) (2013) Ketamine: A review of use and harm. London: Home Office. Available at: https://www.gov.uk/government/publications/ketamine-a-review-of-use-and-harm

Advisory Council on the Misuse of Drugs (ACMD) (2026) Ketamine: An updated review of use and harms. London: Home Office. Available at: https://www.gov.uk/government/publications/ketamine-an-updated-review-of-use-and-harms

Berman, R.M., Cappiello, A., Anand, A., Oren, D.A., Heninger, G.R., Charney, D.S. and Krystal, J.H. (2000) ‘Antidepressant effects of ketamine in depressed patients’, Biological Psychiatry, 47(4), pp. 351–354. https://doi.org/10.1016/S0006-3223(99)00230-9

Le Daré, B., Pelletier, R., Morel, I. and Gicquel, T. (2021) ‘History of ketamine: An ancient molecule that is still popular today’, Annales Pharmaceutiques Françaises. https://doi.org/10.1016/j.pharma.2021.04.005

National Institute for Health and Care Excellence (NICE) (2022) Esketamine nasal spray for treatment-resistant depression. Technology appraisal guidance TA854. Available at: https://www.nice.org.uk/guidance/ta854

World Health Organization (WHO) (2025) The selection and use of essential medicines, 2025: WHO Model List of Essential Medicines, 24th list. Geneva: World Health O