Breastfeeding can be a beautiful experience, but it comes with challenges that don’t always get talked about. If you’ve ever felt a sudden wave of negative emotions like sadness, anxiety, or irritability just before your milk lets down, you might be experiencing Dysphoric Milk Ejection Reflex, or D-MER.

According to Kindred Bravely’s in-house Certified Lactation Counselor Kori Motes, “Dealing with D-MER can feel frustrating and even isolating, but it’s not as uncommon as you might think. Some studies estimate that up to 9% of lactating mothers share this experience. You’re not alone – and it doesn’t last forever.”

While this condition isn't widely discussed, being aware of it can help you understand what's happening in your body and feel more supported in your breastfeeding journey. And never hesitate to contact your healthcare team for personalized guidance.

What is D-MER?

Dysphoric Milk Ejection Reflex is a physiological response that causes brief but intense negative feelings – like sadness, dread, or irritability – just before or during your milk letdown. It typically happens within seconds to minutes of the letdown reflex, then fades soon after. These emotions are unrelated to how you feel about breastfeeding or your bond with your baby, and they’re not your fault. They’re a chemical response in the body that can catch you off guard.

It’s important to know that D-MER is not the same as postpartum depression (PPD) or anxiety, though these issues can coincide. Unlike PPD, D-MER is directly tied to the act of nursing or pumping and is momentary, lasting only for the duration of the letdown.

What causes D-MER?

While the exact cause of D-MER isn’t fully understood, researchers think it’s linked to a drop in dopamine, a key neurotransmitter in the brain. During milk letdown, dopamine naturally decreases, allowing prolactin, the hormone that helps with milk production, to rise. For most moms, this shift happens seamlessly. But for moms with D-MER, the drop in dopamine might trigger a wave of negative emotions.

Think of it like a hiccup in your body’s chemical balance. It’s not a reflection of your emotional state, your love for your baby, or your ability to breastfeed. It’s simply your body’s unique way of reacting to hormonal changes. 

What does D-MER feel like?

D-MER can feel different for everyone, but common symptoms include:

• A sudden wave of sadness, emptiness, or despair.

• Anxiety or panic.

• Irritation or anger.

• Seasickness or nausea.

• Intense thirst.

These sensations are often described as intense but fleeting, lasting anywhere from 30 seconds to a few minutes. While they can be overwhelming, they typically disappear as your hormones stabilize.

What can you do about D-MER?

If you think you’re experiencing D-MER, the good news is that it’s manageable. Here are some steps to help you navigate it:

1. Learn about it.

Understanding D-MER can make a huge difference in how you cope. Knowing it’s a chemical response – and not a response to how you feel about breastfeeding – can help you feel more in control. Share information about D-MER with your family and friends so they can offer support and understanding.

2. Track patterns.

Keep a simple log of when D-MER happens and what it feels like. This can help you identify patterns, such as whether it’s more intense at certain times of day, if it’s linked to dehydration, your food intake, tiredness, stress, etc. 

3. Prioritize self-care and bonding.

Taking care of yourself physically can help manage the intensity of D-MER. Stay hydrated, eat nutrient-rich meals, and rest as much as possible. Small acts of self-care can make a big difference. Adding extra skin-to-skin contact with your baby can also help lower your cortisol levels and heart rate. 

4. Practice mindfulness.

Mindfulness techniques, like deep breathing or grounding exercises, can help you manage the emotional wave when it comes. Focusing on your breath or repeating a calming mantra can anchor you during those brief moments of distress.

5. Seek professional support.

If D-MER is significantly affecting your breastfeeding experience or mental health, reach out to your healthcare provider or a lactation consultant. They can help you explore strategies to manage D-MER and discuss whether additional support might benefit you.

You are not alone.

D-MER can feel isolating, especially if you’ve never heard of it. But many moms have walked this path and found ways to navigate it. Remember, you’re doing an incredible job, and there’s no one-size-fits-all path to motherhood.

Breastfeeding is a journey, and every journey has its ups and downs. If D-MER is part of your experience, know it’s temporary and manageable with the right tools and support.

If you’re experiencing thoughts of harming yourself or others, call or text the Postpartum Support International Helpline at 800-944-4773 (4PPD) or go to your nearest emergency room.  

Frequently Asked Questions About D-MER

1. What is D-MER, and how is it different from postpartum depression?
D-MER (Dysphoric Milk Ejection Reflex) is a brief emotional response triggered by milk letdown during nursing or pumping. It typically involves a sudden wave of sadness, anxiety, or irritability. Unlike postpartum depression, D-MER is momentary and directly linked to the physical act of milk release, not ongoing feelings about motherhood or life in general.

2. How common is D-MER?
D-MER is believed to affect approximately 9% of breastfeeding mothers, though it is likely underreported. Many moms feel confused or ashamed by the symptoms and don’t realize they’re experiencing a recognized condition.

3. When does D-MER usually start, and how long does it last?
D-MER often begins in the early weeks of breastfeeding but can appear anytime during lactation. The dysphoric feelings usually last only a few seconds to a few minutes, resolving soon after milk letdown.

4. Can D-MER go away on its own?
Yes, for many moms, D-MER improves over time as hormone levels stabilize or as their breastfeeding journey progresses. Some may notice it becomes less intense or frequent, while others may not experience it after the first few months.

5. Is there a treatment for D-MER?
There is no specific medical treatment for D-MER, but awareness, self-care, hydration, mindfulness techniques, and support from lactation professionals can help manage symptoms. In some cases, supplements or medications to support dopamine levels may be considered under medical guidance.

6. Can you have D-MER while exclusively pumping?
Yes, D-MER can occur during pumping as well as nursing. It’s tied to the milk ejection reflex, not the way milk is expressed.

7. Can D-MER affect your milk supply?
D-MER itself doesn’t impact milk production, but stress or anxiety associated with the experience could potentially affect supply over time. Prioritizing support and coping strategies can help you maintain a healthy breastfeeding routine.

8. Is it safe to continue breastfeeding with D-MER?
Yes, it is safe to continue breastfeeding. D-MER is a physiological response, not a sign that something is wrong with your milk or your ability to breastfeed. Support and understanding are key to managing it.

9. Should I talk to my doctor about D-MER?
Absolutely. If D-MER is causing distress or affecting your breastfeeding experience, it’s important to bring it up with your healthcare provider or a lactation consultant. They can offer support, reassurance, and explore any underlying issues that might be contributing.

10. Can mindfulness really help with D-MER?
Many moms find that mindfulness practices – like deep breathing, guided imagery, or grounding exercises – can ease the emotional wave of D-MER. These tools can help you stay centered and reduce the intensity of the experience.

Disclaimer: This content is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider.