Negative feelings during breastfeeding.
We lactation consultants often tell new parents that, when we’re breastfeeding, there’s a surge of oxytocin in our bloodstream, and it’s the high level of this chemical that will heighten our love and connection with our baby. But what happens when someone has the opposite experience of breastfeeding?
Dysphoric Milk Ejection Reflex (D-MER) is a condition that causes undesirable feelings right before a release of breast milk, commonly (and here, rather ironically) known as a “let down.” This occurs during breastfeeding or pumping, but also happens at other times, such as when a lactating parent hears a baby cry.
How it’s Described:
The undesirable feelings generally occur along a spectrum of three different emotions - depression, anxiety and anger. The intensity of the emotions and how they are experienced can vary widely. Here are some of the ways that D-DER has been described:
Restlessness
Homesickness
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
Terrible feelings of sadness
Emptiness
Rage
Difficulty concentrating
Typically these feelings come on abruptly, immediately before a milk release. As the milk releases, the feeling subsides. Some people experience these emotions with each milk release, others more occasionally. Many will experience it with at least the very first milk release of a nursing or pumping session.
“I thought it [DMER] would go away. But it just became my new normal. And with a brand new baby exclusively breastfeeding and latching up to a dozen times a day, it was like being on the worst emotional roller coaster ride of my life.”
Most parents with D-MER understandably start to dread breastfeeding. Some will discontinue lactation earlier than they planned, due to the difficulty of managing the intensity and frequency of negative emotions. 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.
Occurrence:
D-MER is a newly recognized condition, thus we have very limited research on it. It was first identified in the medical community around 2007 and the first formal case report was published in 2010.
Based on the few studies that we do have, D-MER affects between 6% and 25% of lactating individuals, which is similar to the incidence of postpartum depression. Given this high percentage, routine postpartum screening for D-MER should be standard and all expectant parents should be counseled on it.
Unfortunately, some medical professionals who treat postpartum patients are not yet aware of the existence of D-MER. It isn’t being routinely screened for, even by providers who do know about it.
From a 2024 study in Japan, 25% of parents began to experience D-MER symptoms within a few days of giving birth, but it can begin at any point during the lactation experience.
In 2008, Alia Heise, a new mother who was struggling to find help for her symptoms, founded the website d-mer.org. Through this website, many parents have found resources, shared their own stories and have begun to put the pieces of this condition together for themselves.
Cause:
Due to poor public awareness of D-MER and the lack of evidence-based research, many parents and clinicians alike may mistake D-MER for postpartum depression (PPD). Although they are different disorders, people who experience PPD are more likely to experience D-MER.
Case studies do suggest that psychotherapy may be helpful in the management of D-MER symptoms. As a reflex, however, it isn’t something that can be stopped. Think of this in the same way that your leg kicks out in response to a doctor tapping your knee with a reflex hammer.
Our understanding of what causes D-MER is still in the theoretical phase. There have been several theories about what causes D-MER, all having to do with neurochemistry. People have theorized that there could be a problem with oxytocin, serotonin or dopamine levels in parents who suffer from this. A case report from 2011 suggests that an abrupt drop in dopamine may occur with milk release, and this abrupt drop may elicit negative responses for affected individuals.
Treatment:
Many parents are uncomfortable discussing symptoms with their loved ones or caregivers. Their reasons for staying quiet may include:
Their belief that anyone they tell will automatically urge counseling or antidepressants as a solution.
Embarrassment at not having the positive feelings they were "supposed" to have.
Their fear that no one else has this odd reaction to breastfeeding.
Alerting new mothers to the existence of D-MER allows sufferers to connect with others having a similar experience and to feel more at ease with their reaction to breastfeeding.
Before finding out about D-MER, many new parents will attribute these negative feelings to the baby blues or postpartum mood disorders. Hearing that it’s a medical condition, and not all in their head, is often a bit of a relief to new parents. For some, acceptance of the emotions is easier knowing that there is a reason for it.
In some cases, lifestyle changes can help. Keeping a journal and noting anything that seems to make the feelings worse can be helpful. Some parents have noted caffeine, stress, lack of sleep and dehydration to exacerbate the feelings.
Other strategies that parents have identified as helpful are:
Relaxation/meditation
Deep breathing
Distraction
Skin-to-skin contact with their baby
Increased sleep
Increasing water intake
Exercise
Solitude
Music
Aromatherapy
Finding a support network can also be helpful. Breastfeeding cessation will be necessary for some. From a recent study, about half of women did not experience relief from symptoms until they fully weaned.
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 escitalopram or sertraline.
There is no official test to diagnose D-MER at this time. Describing your symptoms will lead to the diagnosis.
If you suspect that you have D-MER, discuss your symptoms with your perinatal provider. If they aren’t familiar with it, look for a breastfeeding medicine physician either in your area or available virtually. This resource can help you find a medical provider who is knowledgeable about breastfeeding.
Know that you are not alone and that you can get help.
Further reading:
DMERS and Nipple Nerve Pain (The Physician’s Guide to Breastfeeding)
Dysphoric Milk Ejection Reflex (Australian Breastfeeding Association)
Dysphoric Milk Ejection Reflex Among Japanese Mothers: A Self Administered Survey
