Dysphoric Milk Ejection Reflex: What You Need to Know
Breastfeeding is often thought of as a pleasant and joyful bonding experience for a new parent and their baby, but what happens when it isn’t? We are going to explore a condition called Dysphoric Milk Ejection Reflex, or D-MER, which occurs in a small percentage of lactating individuals. While little is known about it, raising awareness is important in helping to manage the condition and to be able to enjoy your breastfeeding experience.
What is D-MER?
First, let’s talk about your milk ejection reflex. If you are unfamiliar with the term, the milk ejection reflex (also known as the let-down reflex), is the action that releases milk from your breasts during a breastfeeding or pumping session. Some nursing parents feel the reflex as a tingling sensation, and you may notice that your baby’s sucking pattern changes in response to the sudden spray of more milk. The reflex occurs when there is a maternal rise in oxytocin during the feeding session. With the rise in oxytocin, there is a drop in dopamine.
Dysphoric Milk Ejection Reflex (D-MER) is a rare condition that occurs when the breastfeeding parent feels an abrupt range of negative emotions just before/during milk ejection reflex. These feelings are often described by parents as profound sadness, panic, hopelessness, dread, anger, irritability, anxiety, and depressive thoughts. They are characterised by a sudden onset and last from a few seconds up to several minutes. D-MER can be mild, moderate, or severe depending mostly on the intensity of emotions and how many let downs in a feeding or pumping session.
Why does D-MER happen?
D-MER is not associated with disliking breastfeeding and should not be confused with postpartum depression/anxiety or baby blues. The true cause of D-MER is not yet known, but it is thought to be related to the sudden changes in hormones during let-down. The spike in oxytocin may resemble a fight-or-flight response associated with PTSD, mistakenly activating the breastfeeding parent’s defence reactions rather than loving, bonding feelings usually associated with oxytocin and breastfeeding. The additional drop in dopamine may affect your mood regulation as well.
How is D-MER treated?
It is important to note that D-MER is a physiological occurrence, not a psychological one. So, psychotherapy and just “thinking good thoughts” are not helpful in this situation. While there is no standard treatment currently, many parents affected by D-MER recommend the following to be helpful:
Meet with a lactation consultant or join a support group
Use deep breathing/distraction during a let-down
Talking with someone while breastfeeding/expressing milk
Take supplements such as vitamin D, B-complex and probiotics (consult with your healthcare provider before taking any supplements)
Drink cold water or eat a sweet treat during the feeding or pumping session.
D-MER can occur anytime there is a let-down reflex, whether actively nursing or exclusively pumping. Symptoms usually resolve on their own by about 3 months but can last for the entire length of lactation. Remember, D-MER is not a reflection on your feelings towards breastfeeding or motherhood. If you are experiencing D-MER symptoms, visit www.d-mer.org for more information and speak with a lactation consultant to support you throughout your breastfeeding journey.
