Understanding D-MER: When Breastfeeding Triggers Unexpected Emotions
The postpartum period is full of choices a mom must make for her new baby. One of these choices is whether they want to try breastfeeding. The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend exclusive breastfeeding for the first six months of life and up to two years or more with the appropriate added nutrition. Some mothers would like to adhere to this recommendation but encounter challenges that hinder them from doing so. Among these challenges is dysphoric milk ejection reflex (D-MER), an under-recognized condition affecting an estimated 9.1% of breastfeeding mothers.
What is D-MER?
D-MER causes sudden, intense negative emotions and physical symptoms that occur during milk letdown, whether from breastfeeding, pumping, or spontaneous expression. These symptoms can include, but aren’t limited to:
- Anxiety
- Depression
- Hopelessness
- Anger
- Agitation
- Irritability
- Homesickness
- Intense feelings of dread
- Nausea
- Extreme food aversion
These feelings typically dissipate minutes after the milk ejection reflex begins. While some women experience D-MER throughout their entire breastfeeding or pumping journey, some report that these symptoms decrease in severity or go away entirely around three months postpartum.
What causes D-MER?
Unfortunately, there hasn’t been enough research on D-MER to know what causes this condition. Several hypotheses suggest that a hormonal imbalance occurs during the milk ejection reflex or milk letdown. One of the more popular hypotheses targets the hormone dopamine as the most probable cause of the “dysphoric” feelings these mothers feel.
Dopamine is often known as the “feel good” hormone and is associated with feelings of pleasure and reward. Researchers believe that an abrupt decrease in dopamine during the milk ejection reflex causes these strong negative emotions.
The effects of D-MER on the mother
D-MER can have substantial adverse effects on the mother’s mental health. Many mothers report feeling disappointment in themselves, shame, worthlessness, and guilt. Some of these mothers even experience suicidal ideation or thoughts of self-harm or harm to others.
D-MER has been known to disrupt the bonding experience between mother and infant and may lead some mothers to stop breastfeeding. Some women quit altogether, and some women may reduce the frequency of breastfeeding or pumping in an attempt to minimize these feelings. The latter has the potential to cause a decrease in their milk supply, leading to increased stress and/or breastfeeding cessation.
Is there a treatment for D-MER?
D-MER is not well researched; therefore, there is no medically proven or approved treatment. Anecdotally, some women have found some symptom improvement with the use of bupropion, an antidepressant, and pseudoephedrine. Some research suggests that lack of sleep, stress, and caffeine can make the symptoms of D-MER worse. Other research indicates that exercise, staying hydrated, and having a diet with protein can also help improve this condition.
Clinical recommendations and considerations
Education is crucial for supporting women with D-MER, and it’s essential for any healthcare professional working with postpartum women to be informed about the condition. This includes, but isn’t limited to, OB/GYNs, nurses, lactation consultants, and mental health providers.
By educating more healthcare professionals, we can better inform new mothers. Teaching women about this condition has already proven to be an effective intervention. It can be helpful for these mothers to hear that there is nothing wrong with them and that this is a physiologic reaction they cannot control.
It is also crucial for providers to be able to distinguish D-MER from postpartum depression to ensure appropriate diagnosis and treatment. While both conditions may present with similar symptoms, such as feelings of sadness and anxiety, the pattern and duration of symptoms differ significantly. D-MER symptoms occur exclusively during milk ejection reflex and typically resolve within minutes, with women maintaining normal mood between breastfeeding or pumping sessions. In contrast, postpartum depression is characterized by persistent symptoms that occur throughout the day, independent of breastfeeding activities. This distinction is crucial, as misdiagnosis can lead to inappropriate treatment approaches and delayed care. However, it’s important to note that these conditions can coexist, and the presence of one does not exclude the other.
Dysphoric milk ejection reflex (D-MER) remains a largely under-recognized condition, yet it has profound effects on the emotional and physical well-being of mothers during the postpartum period. By increasing awareness and understanding of D-MER among healthcare professionals and new mothers alike, we can help reduce the feelings of confusion, guilt, and shame that many women experience.