What is the Dysphoric Milk Ejection Reflex (D-MER)?

You probably expected to run into a few hiccups throughout your breastfeeding journey, but it’s unlikely that you prepared for the fact that nursing your baby could be punctuated by abrupt negative emotions like sadness, anxiety, or even anger.

For people dealing with Dysphoric Milk Ejection Reflex (D-MER), the hormonal changes that occur in the moments prior to feeding your baby can trigger fleeting but intensely negative feelings, such as self-loathing and hopelessness.  

For those experiencing these symptoms, it can feel isolating, confusing, and hugely debilitating. Let's take a closer look at what D-MER is and how breastfeeding parents can cope with it.  

What Is D-MER?

D-MER is a recently recognized condition and, as such, few studies have been conducted on it. However, we do know that it affects lactating parents and is thought to be caused by the hormonal changes that occur shortly before let-down.

“D-MER is an anomaly of the milk ejection reflex that causes a brief but often intense wave of dysphoria when the milk release is triggered. It is experienced and felt right before the milk releases from a mother's breast,” says Alia Macrina Heise, IBCLC, an International Board Certified Lactation Consultant who is widely considered to be the authority on the subject after suffering from and identifying the condition herself.

Key Characteristics of D-MER

Each experience of D-MER can vary, with people experiencing it feeling a range of emotions from homesickness to hopelessness. These feelings typically last no longer than a few minutes and in between episodes of D-MER, the parent feels fine. 

“The severity of the emotional experience varies depending on how severely the mother has D-MER,” explains Heise. There are three D-MER severity levels: mild, moderate, and severe. 

D-MER sufferers experience dysphoria approximately 30-90 seconds before they release milk from the breast, regardless of whether that's during nursing, pumping, or a spontaneous let-down (leak).

So, for a parent who is breastfeeding eight times a day, this would mean having eight, 10, or 20 let-downs within a 24 hour period, explains Verity Livingstone, MD, IBCLC, founder of the Vancouver Breastfeeding Centre. "It is a rare condition but for those mothers who experience the symptoms, it can be devastating," says Dr. Livingstone. 

D-MER and Postpartum Depression

As D-MER is still relatively poorly understood, it is commonly misdiagnosed as postpartum depression. However, for people dealing with D-MER, the symptoms are so distinct that it is easy to differentiate between the two.   

“A mother can have both postpartum depression and D-MER, but when you talk to those mothers they can easily distinguish between the two experiences and the continual, ongoing struggle of postpartum depression versus the brief but intense drop of dysphoria before her milk releases," Heise explains. 

If you can't distinguish between the two conditions or are feeling overwhelmed by negative emotions, reach out to a healthcare provider for further advice.

How Common Is D-MER?

While D-MER was initially considered to be rare, recent evidence suggests that it could be more common among breastfeeding parents than mastitis.

"Interestingly enough, that is a prevalency rate that is higher than the condition of mastitis," explains Alia. "And almost every mother who has a baby and plans on breastfeeding has heard about mastitis, and yet hardly any mothers who have a baby and plan on breastfeeding has heard about D-MER."

What Causes It?

We don’t know exactly what causes D-MER yet. However, as the dysphoria associated with it occurs directly before let-down, there is a strong suggestion that it is linked to a physiological response to the drop in the hormone dopamine. 

Before breastfeeding, levels of the pleasure-neurotransmitter dopamine lower in order for oxytocin—the feel-good hormone that plays a key role in labor, breastfeeding, and parent-child bonding—levels to rise and prompt the release of milk into the breasts.  

However, in D-MER, it is thought that dopamine levels drop too abruptly, causing a brief but intense wave of negative emotion. These feelings subside as the dopamine levels restabilize. 

How to Treat D-MER

At this time, there aren't any diagnostic tests to confirm that you have D-MER. There also are not any evidence-prescribed treatments for it. However, Heise recommends keeping a log of what appears to aggravate your D-MER, like fatigue or caffeine, and what appears to alleviate it, such as hydration or exercise.

She also maintains that seeking solace in the fact that D-MER is a real condition and that you aren't alone in it goes some way to help.

"Generally, mothers do well once they know they’re not alone, once they know they’re not crazy, once they know that what they’re experiencing has a name, and once they find the proper resources for support with other mothers," says Heise. "Validation of their experience is impactful, significant, and the most useful tool we have right now until we have a more reliable and safe treatment."

Dr. Livingstone echoes this: "The most important message is to recognize the condition and acknowledge our lack of understanding and that positive support can go a long way to modulate the feelings."

When to Seek Professional Help

D-MER is still relatively unknown in some medical circles. If you plan to discuss your experience with a healthcare provider, you should prepare yourself for the possibility that they have not heard of it, warns Dr. Livingstone. Instead, Heise advises talking to a board-certified lactation consultant. 

"If a mother has severe D-MER in a way that she feels like its impacting on her relationship with herself and with her infant, then talking to a lactation consultant about managing her breastfeeding goals and perhaps modifying them in order to prioritize a different area of health may be necessary," she says.

A Word From Verywell

For people with D-MER, it can feel lonely, isolating, and hugely distressing. However, know you aren't alone. Seek out support groups to find other people going through the same thing as you. Validation that this is a real, physiological condition may go some way to help manage it.

For additional assistance with managing your symptoms, reach out to a board-certified lactation consultant or healthcare provider.