Imagine you are breastfeeding your baby, and all of a sudden you feel intense sadness, guilt or even anger. The feelings last for 1-2 minutes, then are gone. And every time you breastfeed, they come back. You’d wonder, what is going on with me? What is wrong?
Dysphoric Milk Ejection Reflex (or D-MER) is an abrupt emotional shift that occurs just before the milk letdown in some breastfeeding women, and lasts only a few minutes. Despite causing significant psychological symptoms, researchers believe it is physiological in nature.
The hormones in lactating women – oxytocin, prolactin, and dopamine – usually make breastfeeding a more positive and enjoyable experience. With D-MER this is just the opposite. Normally, the hormone oxytocin is released from the brain when the nipples and areola are stimulated, causing the milk to let down. Prolactin levels gradually rise throughout the feed, and are responsible for ongoing milk production. Dopamine levels must fall in order for Prolactin levels to rise. For mothers experiencing D-MER, there is an inappropriate drop in the level of dopamine (either too fast or too far) as the prolactin level rises, which causes the brief but repeated negative feelings. How and why this happens is not fully understood, as D-MER was only recently recognized and research is limited.
The most effective treatment at this time is awareness, understanding and education. Once a woman with D-MER understands that her condition is physiological and that there are others experiencing the same thing, she is often able to manage her symptoms better without weaning prematurely. Self-care measures such as exercise, proper nutrition, and rest can be helpful for some women along with avoiding triggers such as stress, caffeine and dehydration.
At this time, there are no medications specifically approved to treat D-MER. Although there are many options of foods, herbal preparations and prescription medications that can raise dopamine levels, not all are appropriate for a breastfeeding mother and should be discussed with a physician or health care provider prior to use.
WHAT IF I HAVE D-MER?
D-MER has only recently been recognized as a condition. It was discussed by Lactation Professionals in 2007, and was first mentioned in textbooks in 2010. However, awareness of this condition is steadily growing, so your family physician or health care provider may have heard of it. If you are experiencing repeated and sudden negative emotions when breastfeeding or pumping – anything from anger to guilt to sadness – and these feelings pass after 1-2 minutes, it could be D-MER. Pay close attention to your symptoms, and don’t hesitate to speak with your health care provider.
If you’re wondering about resources or support for D-MER, reach out. Any of our Mama Coaches would be happy to discuss your symptoms and make referrals as needed.