One of the advantages of phototherapy in seasonal affective disorder is that the use of antidepressant drugs may be avoided. However, many patients with winter depression use phototherapy concomitantly with antidepressant medication without an apparent potentiation of adverse effects. When used for non-seasonal depression bright light is usually combined with pharmacotherapy. In general this seems a safe procedure, but the adverse effects of light may add to the side-effect burden of medication.

It was originally suggested that the beneficial effects of light in seasonal affective disorder may be due to the suppression of plasma melatonin levels. Melatonin secretion is regulated by noradrenergic b-adrenoceptors and there is, in fact, some limited evidence that b-adrenoceptor blockers have antidepressant activity in winter depression/10) Melatonin is available in some countries as an over-the-counter preparation, and, theoretically, melatonin self-medication could offset the therapeutic effects of light treatment.

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