Many parents choose to breastfeed their babies and assume it is always a happy and fulfilling experience. However, not everyone experiences positive feelings about breastfeeding, which can lead to lots of concern. 

For some parents, breastfeeding fills them with negative emotions. If these depressive feelings correspond with your milk letting down, it could be a condition called dysphoric milk ejection reflex. Keep reading to learn more about dysphoric milk ejection reflex and how it’s treated. 

What is Dysphoric Milk Ejection Reflex?

Dysphoric milk ejection reflex (D-MER) is a relatively rare condition that some breastfeeding women 

 experience. It is often described as a sudden influx of negative emotions while breastfeeding, corresponding to milk letdown (ejection). 

The term dysphoric refers to a state of dissatisfaction, anxiety, restlessness, or fidgeting. These negative feelings often range from mild wistfulness to self-loathing. Anxiety, dread, sadness, anxiousness, angst, and hopelessness have all been used to describe this feeling. 

D = Dysphoria 

MER = Milk ejection reflex ( let-down)
Women with D-MER experience negative emotions seconds before their let-down reflex. It can happen with chestfeeding or pumping, but also at times when the breasts let down when NOT chestfeeding or pumping. These feelings of dysphoria can last for a few minutes.

Frequently Asked Questions About D-MER

Are you or a loved one experiencing dysphoric milk ejection reflex? Here are some of the most frequently asked questions regarding D-MER. 

What causes D-MER?
Many theories have circulated as to what causes D-MER. One current theory is that D-MER occurs as a result of an abrupt drop in dopamine that occurs with let-down, which exaggerates the let-down reflex. 

Other researchers hypothesize that dysphoric milk ejection reflex occurs due to an exaggerated “fight or flight” response triggered by the oxytocin released during letdown. However, one important thing to remember is that mom doesn’t cause it. Simply put, it’s a hormonal problem.

What are the symptoms of D-MER?

Some of the most common symptoms of D-MER include anxiety, sadness, dread, nervousness, angst, and irritability, to name a few. Some moms with D-MER experience mild symptoms, while others severe enough that they can have suicidal thoughts or thoughts of self-harm. 

Symptoms often decrease by three months postpartum but can last for the duration of breastfeeding.  

How is D-MER different from postpartum depression or anxiety disorder?
D-MER-associated negative emotions happen ONLY with the let-down reflex and generally do not last more than a few minutes. 

Postpartum depression, on the other hand, is a more severe, long-lasting form of depression. These severe symptoms can interfere with the ability to care for the baby and other daily tasks. Symptoms usually develop within the first few weeks after giving birth but can begin during pregnancy up to a year after birth.

How do you treat dysphoric milk ejection reflex?

If you or a loved one is experiencing D-MER, talk with your doctor. 

Very often, moms have felt embarrassed or ashamed to have these feelings/emotions, so they are afraid to talk about them. When they have spoken up, they have been dismissed. 

However, the more women speak up about it, the more awareness there is, which can help demystify it and make it easier to talk about. 

Treatment varies for dysphoric milk ejection reflex. For mild symptoms, lifestyle changes are often helpful. For example, distracting yourself while breastfeeding (eating or watching your favorite show on tv).  Have a glass of water and a healthy snack with you each time you sit down to nurse your baby. 

Avoiding things that make symptoms worse, like caffeine and dehydration, is helpful. Additionally, ensure that you prioritize sleep. Lack of sleep seems to worsen symptoms for some women experiencing D-MER.  

If symptoms are severe, your doctor may discuss other options, like weaning or pharmacological treatments (ie: medications that increase dopamine levels).  

Here are additional resources that might be helpful:

• www.D-MER.org
• There is a Facebook group that is active with posts and discussions called Dysphoric Milk Ejection Reflex (D-MER) Support Group from d-mer.org.