There are no absolute contraindications to phototherapy, except the obvious caveat that since the therapeutic effect depends on retinal activation, subjects must have sufficient visual function to allow this to occur. Otherwise it would seem unwise to use phototherapy in patients with pronounced and untreated agitation because this symptomatology could be worsened. In addition, evening phototherapy may worsen insomnia.

A substantial minority of patients with seasonal affective disorder meet the criteria for bipolar II disorder, which raises the concern that phototherapy could trigger hypomanic mood swings in such subjects. In practice, however, this does not commonly cause management difficulties.(6) More caution might be needed in patients with a bipolar I syndrome, particularly in the absence of mood stabilizing medication. It is worth noting that some regimes of phototherapy result in a degree of sleep deprivation that may destabilize mood in bipolar patients.

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