By Sharon Berger, IBCLC, RN

When we’re breastfeeding, there’s a surge of oxytocin in our bloodstream, and it’s the high level of this chemical that helps to heighten our love and connection with our baby. But what happens when someone has the opposite experience during breastfeeding?

Dysphoric Milk Ejection Reflex (D-MER) is a condition that causes undesirable feelings right before a release of milk, which is commonly (and here, rather ironically) known as a “let down.”

How it’s Experienced

These feelings generally occur along a spectrum of three different emotions – depression, anxiety, and anger. The intensity of the emotions and how they’re experienced can vary widely. Here are some of the ways that D-MER has been described:

●      An overwhelming feeling of guilt, shame, or worthlessness
●      A sense of doom and despair
●      Wanting to crawl out of one’s skin
●      A desire to hide from the world
●      A hollow feeling in the stomach
●      Emptiness
●      Rage

Typically, these feelings come on abruptly, immediately before a “let down.” As the milk begins to flow, the feelings subside. Some will experience it with every “let down,” others more occasionally. Most will experience it with the first milk release at the start of a nursing or pumping session. 

These intense feelings can affect postpartum mental health, hinder bonding with the baby, and may lead some to stop breastfeeding earlier than planned. Parents with D-MER can understandably start to dread breastfeeding. They may say, “I just didn’t like breastfeeding,” without ever understanding that there was a physical reason. 

Some parents report lessening of symptoms with time, and others not until they’ve fully weaned. In a recent study, 45% of parents who experienced the condition stopped breastfeeding because of it.

Occurrence

D-MER is a newly recognized condition, thus we still have very limited research on it. Based on the few studies that we do have, D-MER may affect up to 25% of lactating individuals, which is similar to the incidence of postpartum depression (PPD).

Given this high percentage, routine postpartum screening for D-MER should be standard. Additionally, all expectant parents planning to breastfeed should be counseled on it. Unfortunately, some perinatal providers are not yet aware of the existence of D-MER, and even when providers do know about it, it isn’t being routinely screened for.

Parents often hesitate to discuss their symptoms with providers due to embarrassment about not feeling the expected joy of breastfeeding or the belief that no one else shares their experience.

At this time, there is no official test to diagnose D-MER. Describing your symptoms will lead to the diagnosis.

Cause

Due to poor public awareness and a lack of research, D-MER is commonly mistaken for postpartum depression (PPD). Sufferers may be told to seek therapy or be prescribed antidepressants. Although these are different disorders and should be treated as such, people who experience PPD are more likely to experience D-MER.

Our understanding of what causes D-MER is still in the theoretical phase. People have theorized that there could be a problem with oxytocin, serotonin, or dopamine levels in parents who suffer from this. More research needs to be done to develop better treatment.

Management and Treatment

Alerting new parents to the existence of D-MER allows sufferers to connect with others having a similar experience, which can allow them to feel more at ease. Hearing that it’s a medical condition and not all in their head is often a relief to new parents and can help them with acceptance.

Keeping a journal and noting anything that seems to make the feelings worse can also be helpful. Some parents have noted caffeine, stress, exhaustion, and dehydration to exacerbate the feelings. Strategies that parents have identified as helpful are:

●      Relaxation/meditation/deep breathing
●      Distraction
●      Skin-to-skin contact with their baby
●      Getting adequate sleep
●      Staying well hydrated
●      Exercise
●      Solitude
●      Music
●      Aromatherapy

Although there is no agreed-upon pharmaceutical treatment, based on case reports and clinical practice, patients have seen good responses with the use of norepinephrine/dopamine reuptake inhibitors (NDRIs) such as bupropion and selective serotonin reuptake inhibitors (SSRIs) such as sertraline. 

Additionally, finding a support group or seeking therapy may help manage symptoms. Breastfeeding cessation will be necessary for some.

If you suspect that you have D-MER, reach out to your perinatal provider. If yours isn’t familiar with it, look for a breastfeeding medicine physician either in your area or available virtually. www.bfmed.org/find-a-physician can help you find a doctor who is knowledgeable about breastfeeding. Remember you are not alone, having D-MER doesn’t make you a “bad parent,” and most importantly, help is available.

About the Author

Sharon Berger, RN, IBCLC

Sharon has worked in reproductive health care settings for over 20 years and is the owner of Our Milk House, a private lactation consulting practice. Her guiding principle is to meet people where they’re at, and she is passionate about providing individual, compassionate, and evidence-based care.
Sharon lives in upstate New York with her husband and their sweet old dog. Her other passions include making sourdough bread, gardening, hiking, and visiting with her amazing adult children as often as possible.

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