Parent with a lactation bite holding infant

Sadness During Breastfeeding and D-MER

Breastfeeding is usually associated with positive feelings – bonding with baby, relaxation, contentment – but some breastfeeding parents might experience a sudden and intense drop in mood at the start of a breastfeeding or pumping session. This feeling may not just be mental or emotional, it may be a physical response. D-MER, or Dysphoric Milk Ejection Reflex could be the cause of these sudden negative feelings for some nursing mothers.1

What is D-MER?

Dysphoric Milk Ejection Reflex was first identified in 2007 by Alia Macrena Heise, an IBCLC that was experiencing unusual symptoms while she was breastfeeding. D-MER is a condition that can affect people that are lactating that's characterized by a sudden feeling of unhappiness, unease, or other negative emotions when letdown (when breast milk begins to flow) occurs.1 It may last for just a few seconds or minutes, but can be extremely intense and distressing. It can happen when breastfeeding, pumping, expressing, or any time you experience a sudden letdown of milk. Experiencing these feelings can be so uncomfortable that it deters some parents from continuing to breastfeed or pump. In some extreme cases, D-MER can lead to suicidal thoughts. It's important to seek medical attention immediately if this occurs.

Is D-MER the Same as Postpartum Depression?

D-MER is not the same as postpartum depression. Postpartum depression is a constant, ongoing feeling while D-MER occurs specifically during the moments of milk ejection (letdown) and ends shortly after, usually around 60-90 seconds.1 It is possible to have both postpartum depression and D-MER.

How Can I Tell if I have D-MER?

Tell your doctor if you have any variety of these negative feelings at letdown, which may be caused by D-MER:1

  • Sadness or hopelessness
  • Low self-esteem
  • Dread or a sinking feeling
  • Anxiety
  • Agitation or irritability
  • A hollow or churning feeling in the stomach
  • An unwanted sense of obligation to the baby

According to Alia Heise's findings, there are three levels of emotions experienced during D-MER: despondency (sadness, hopelessness), anxiety, and agitation.1 It's been observed that women with milder cases of D-MER only experience despondency and it self-corrects within the first 3 months of breastfeeding, moderate cases experience anxiety and despondency and D-MER can last 6-12 months, and more severe cases experience all three levels of emotions and it can last until baby is weaned.2

The feelings around D-MER can cause psychological stress beyond the feelings in the moments of letdown. Nursing mothers may feel guilty that they don't enjoy breastfeeding when it's expected to be a beautiful, bonding experience and give you a sense of achievement after feeding. It can put undue pressure on the mother, impacting her self-esteem, desire to breastfeed, and even her relationship with baby.3

It's possible that you may have D-MER if you experience these symptoms specifically during letdown. However, it's normal to have some or all of these feelings in the postpartum period. If you are experiencing any of these feelings intensely and they are impacting your day-to-day life, contact your doctor as soon as possible.

What Causes D-MER?

Research is limited, but there have been some studies exploring the cause of D-MER. According to Alia Heise, a sudden drop in dopamine is the main cause.1 Dopamine is a neurotransmitter and hormone that gives you a feeling of pleasure and satisfaction. The two main hormones associated with breastfeeding are oxytocin and prolactin. Oxytocin, prolactin, and dopamine levels are all rising and falling when a person is lactating, and prolactin and dopamine levels affect each other:

"The secretion of prolactin, which also happens during lactation, is dependent on the inhibition of dopamine."4

So, when a mother's prolactin increases to make milk, her dopamine levels drop. And in the case of D-MER, drop suddenly, causing the negative feelings.

It isn't known why some women have D-MER and others don't. Alia Heise states, "It could be an environmental effect, a nutritional deficiency, a breakdown in normal hormonal activity as she ages. It could be she is more sensitive to a normal drop in dopamine, dopamine receptor mutation, a predisposition to abnormal dopamine activity or some other unknown cause."1

How Do You Treat D-MER?

Since D-MER is not well understood yet, there are no official treatments. There are techniques that mothers can try to help ease the effects of D-MER such as:3

  • Relaxation techniques like deep breathing and meditation
  • Distracting yourself during letdown – watching TV, eating, listening to music, etc.
  • Increasing skin-to-skin contact with baby
  • Seeking support from friends and family – talking about it can be a relief

Reaching out to your doctor is important, especially when your feelings become difficult to cope with. They may prescribe anti-anxiety or anti-depression medications, but luckily, D-MER is temporary. The feelings usually only last a few moments, and most women stop experiencing D-MER within a few months of breastfeeding. If breastfeeding or pumping is too uncomfortable, formula is always a good option for feeding baby.

DISCLAIMER: THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE
The information contained is for informational purposes only and is NOT intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not rely solely on this information. Always seek the advice of your healthcare provider.

Sources

  1. Heise, Alia Macrina. D-MER.org. 2024. https://d-mer.org/understanding-d-mer Accessed 14 May 2024.
  2. Alia M Heise and Diane Wiessinger. Dysphoric Milk Ejection Reflex: A Case Report. International Breastfeeding Journal. 6 June 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126760/ Accessed 14 May 2024.
  3. Dysphoric Milk Ejection Reflex (D-MER). Cleveland Clinic. Medically review 6 April 2023. https://my.clevelandclinic.org/health/diseases/24879-dysphoric-milk-ejection-reflex Accessed 13 May 2024.
  4. Reem Deif, Emily Michelle Burch, Jihan Azar, Nouran Yonis, Macy Abou Gabal, Nabila El Kramani, and Duaa Dakhl Allah. Dysphoric Milk Ejection Reflex: The Psychoneurobiology of the Breastfeeding Experience. Frontiers in Global Women's Health. 29 October 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594038/ Accessed 15 May 2024.

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