Dysphoric Milk Ejection Reflex (D-MER)

What is dysphoric milk ejection reflex (D-MER)?

Dysphoric milk ejection reflex, or D-MER, is a condition that affects people who breastfeed (chest feed) or pump milk. It causes sudden and intense negative emotions just before you “let down” or release milk. It’s quick and lasts just a minute or two. However, it can cause intense unhappiness (dysphoria) and other unpleasant emotions. It can also happen if your breasts accidentally have a let down at any other time, which can be common during lactation.

As the name suggests, this condition is a reflex and something you can’t control. Research is limited, but suggests it’s hormonally driven (related to the chemicals in your body). It’s physical, not psychological, and has nothing to do with not wanting to breastfeed or with having nipple pain. Rather, it’s your body reacting to the release of milk due to a sudden decrease in specific hormones.

Treatment for D-MER involves using different coping strategies to promote relaxation and calming thoughts. Often, people find they’re able to manage symptoms after several weeks.

How common is D-MER?

Researchers are still learning more about D-MER. One study estimates that between 5% and 9% of lactating people experience D-MER. It’s unrelated to postpartum depression (PPD) and postpartum anxiety, although people may have D-MER in addition to those conditions.

What are the symptoms of D-MER?

There are several common symptoms of D-MER, but all revolve around negative thoughts. The negative feelings come quickly and leave quickly, lasting anywhere from 30 seconds to two minutes. It only occurs just before you feel your milk let down. After milk begins to flow, the negative emotions disappear.

People with D-MER can experience the following feelings:

• Sadness or hopelessness.
• Self-hate or low self-esteem.
• Sinking feeling in their stomach or feelings of dread.
• Anger, sadness or agitation.
• Anxiety or irritability.

D-MER has nothing to do with nipple pain, engorgement or other irritations associated with breastfeeding or pumping. However, the feelings may be so intense that they lead you to stop breastfeeding or pumping.

It’s important to note that some people’s symptoms are severe and may lead to suicidal thoughts. If you experience thoughts of wanting to hurt yourself or others, please seek medical attention immediately. People with postpartum depression may find it harder to manage symptoms of D-MER.

What causes D-MER?

Little is known about the condition. But most studies show that hormones — specifically, an abrupt decrease in a hormone called dopamine — cause D-MER. Dopamine is a hormone associated with reward and mood. Many studies show low dopamine levels can have a negative effect on your mood and emotions.

When you breastfeed, your body releases prolactin (a hormone necessary for milk production) and oxytocin. Oxytocin is the hormone that triggers the flow or ejection of milk from your breasts when your baby suckles (or you begin pumping). Oxytocin suppresses dopamine, which means your dopamine levels decrease. For reasons researchers don’t completely understand, some people’s dopamine levels drop very quickly and cause a sudden feeling of unhappiness and other negative emotions. This is D-MER.

These negative feelings are temporary and subside once your prolactin and oxytocin levels return to normal. Most people report their mood stabilizes again within minutes.

It’s important to remember that D-MER is a physical response and not a psychological response. It doesn’t mean you’re depressed or angry at your baby or that you hate breastfeeding. If you think you have D-MER, talking to your healthcare provider, midwife or lactation consultant can help.

How is D-MER diagnosed?

There isn’t a ton of research about D-MER, so there isn’t an official way to diagnose it. Your healthcare provider will talk to you about your symptoms, when you feel them and how intense they are. Remember, D-MER only occurs during feedings or pumping sessions and goes away shortly after. Describing your symptoms and when they happen can help your provider understand what’s happening.

How is D-MER treated?

There isn’t a treatment for D-MER because researchers don’t fully understand it yet. Managing your symptoms and finding ways to cope are both options to manage D-MER.

Some of the most common techniques for managing symptoms of D-MER are:

• Increase skin-to-skin contact: If you’re breastfeeding, try bringing your baby closer to your body. This feeling can lower your cortisol levels and decrease your heart rate, almost like a calming effect.
• Practice meditation or deep breathing: Trying to relax is key. This lowers anxiety and reduces stress. Take deep breaths in through your nose and out through your mouth.
• Find other ways to relax: Getting a massage, listening to music or soaking in a warm tub just before feedings can help relax you and calm you down.
• Distract yourself: Eat, watch TV or do other activities during the milk let down as a distraction.
• Find support: Seek support for D-MER. Whether it’s your partner, a friend or an online support group, find people who’ll listen to you, talk to you and care for you.

How long does D-MER last?

It varies. For most people, D-MER resolves within about three months, getting less severe as their child gets older. But there have been cases where a person experiences D-MER until they’re done breastfeeding.

Can D-MER be prevented?

No, you can’t prevent D-MER. However, it’s important to know that support is available to you and that you didn’t do anything to cause the condition.

Is D-MER a sign of postpartum depression?

No, D-MER isn’t a sign that you have postpartum depression or a postpartum mood disorder. While some of the symptoms overlap, D-MER comes and goes quickly and is specific to when your milk is about to release. However, it’s possible to have both D-MER and a postpartum mood disorder. If negative thoughts and emotions intensify or occur at times other than when you’re nursing or pumping, please speak with your healthcare provider.

How do I take care of myself?

While some people may not understand it, D-MER is a real condition. Fortunately, it’s temporary and there are methods to help you cope. Follow the techniques above to help you manage symptoms of D-MER. Sometimes, just knowing you have a real condition (and others have it, too) can bring you peace.

D-MER may make you want to stop breastfeeding. If the condition takes a toll on your mental health and well-being, it may be for the best for both you and your baby to switch to formula. This is OK. Don’t feel ashamed if breastfeeding doesn’t work for you.

When should I see my healthcare provider?

It’s OK to ask for help. If your feelings are intense and you’re struggling to cope, talking to your healthcare provider or a lactation specialist can help. It’s important to have open and honest conversations about how you’re feeling. It may help to write down your feelings and share them with your provider. Please know there is support available to you and you’re not alone.

If at any point, you have thoughts of hurting yourself or others, please seek medical attention right away.

A note from Cleveland Clinic

Not everyone has a positive experience with breastfeeding. If you feel negative emotions like anger or sadness when your milk lets down, you may have D-MER, or dysphoric milk ejection reflex. You’re not alone, you did nothing to cause it and there’s nothing “wrong” with you. Let your healthcare provider know how you feel so they can discuss the best ways to cope with what you’re experiencing. Sometimes, just knowing there’s a name for what you feel can help you feel less alone.