Mogens Schou - Research

Research

Schou had a long and distinguished career dedicated to research on therapeutic uses of lithium rooted in his deep concern for all patients with mood disorders, initially inspired by the depression and manic-depressive illness that afflicted many of his relatives.

The psychopharmacological era began in earnest in 1949, with the article published by John Cade about the observed antimanic action of Lithium in Australia. Intrigued by these findings Schou, who in the meantime joined the Psychiatric Research Institute of the Aarhus University in Denmark, confirmed these findings in a double-blind placebo-controlled study with his co-workers. This marked the beginning of Schou's illustrious association with lithium.

Since then, there have been a number of interlinked research themes that run through Schou's work. In the 1960s, Schou and Poul Baastrup discovered that long-term lithium treatment prevents the recurrences of illness in bipolar and some unipolar patients and they were understandably exhilarated.

During the early 1960s, G. P. Hartigan, Poul Chr. Baastrup and Schou independently made sporadic observations that were suggestive of lithium also having prophylactic properties in manic-depressive illness. Subsequently, Baastrup and Schou joined together and in a non-blind lithium trial saw their preliminary observations confirmed. They even deemed the results so significant that they concluded that ‘lithium is the first drug demonstrated as a clear-cut prophylactic agent against one of the major psychoses’.

However, the Schou-Baastrup prophylaxis hypothesis was met with great resistance by British psychiatry. To Aubrey Lewis and Michael Shepherd, lithium was ‘dangerous nonsense’. Shepherd, seconded by Harry Blackwell, simply characterized it as ‘a therapeutic myth’, which, in their opinion, was based on ‘serious methodological shortcomings’ and ‘spurious claims’. Even terms such as unethical and unscientific were used. After painful consideration of the ethical aspects invoked, Schou and Baastrup undertook a unique double-blind trial of prospective-discontinuation design and with random allocation of manic-depressive patients (already on lithium) to lithium or placebo, unparalleled in psychiatry. It fully confirmed their hypothesis, published in The Lancet in 1970. Thus, lithium prophylaxis had also become established as evidence based. Lithium became the first-choice mood stabilizer in bipolar affective disorder.

He was aware of some of the limitations of lithium treatment. He welcomed the introduction of other prophylactic agents into the market. From the available observations he concluded, however, that anti-epileptics and atypical anti-psychotics act on different kinds of bipolar patients to lithium.

After he discovered lithium's prophylactic action in mood disorders, he tirelessly researched all its aspects and did not spare any effort to make the treatment available to all those in need. Millions of patients with recurrent mood disorders benefited because of his research. In 1990, authorities on manic-depressive illness such as Fred Goodwin and Kay Redfield Jamison characterized the ground-breaking discovery of lithium prophylaxis as ‘one of the most important advances in modern psychiatry’.

He was an author of more than 500 publications, including texts, research papers, articles and book chapters. He was Emeritus Professor of the Psychiatric Hospital in Risskov, Denmark.