Dysphoric Milk Ejection Reflex in Breastfeeding Moms – Causes, Symptoms, Diagnosis and Treatment

7 min read

Written by Aparna Hari

Aparna Hari

Dysphoric Milk Ejection Reflex

Breastfeeding is the process which makes the inner bond between you and your baby. It is truly a blessing to see your baby nurses upon you. That, a little bud is slowly growing through your nourishment. These talks are true but in reality, sometimes it may not feel that much of a soothing experience. Pregnancy and childbirth are no doubt difficult for all mothers. But this difficulty heightens when your worst negative feelings hit you just at the moment you sit to breastfeed. This condition is called Dysphoric Milk Ejection Reflex or D-MER.

Dysphoric milk ejection reflex can be described as a strange depressive feeling some women feel just at the beginning of breastfeeding times. They feel guilty and blame themselves for not being happy when they should be elated and be at the present of their new baby. If you are going through the same problem, then you are not alone, and this article is just for you. Here are some answers on what is D-MER, what are its signs and causes, and how to treat it. pregnancy pillow

In This Article

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

D-MER is a condition not fully discussed yet. There is not enough research about it even though around 9% of new moms suffer from this. It is just in 2007 when the lactation consultant for the US Department of Agriculture WIC (Women, Infants, and Children), Alia Macrina Heise feel this condition while feeding her third baby and decides to speak about it. She wrote a book on this topic named “Before The Letdown: Dysphoric Milk Ejection Reflex and the Breastfeeding Mother”.

Dysphoric Milk Ejection Reflex as its name suggests is a reflex. It is your body’s immediate reaction before the milk ejection reflex. The ‘D’ stands for ‘Dysphoria’ a state of dissatisfaction, restlessness and anxiety and ‘MER’ stands for ‘Milk Ejection Reflex’ or milk let down.

In the process of milk production, the level of the happy hormone dopamine falls a bit. For some women, the dopamine falls gradually so they do not feel any emotional changes. But for some the dopamine drop happens quickly, thus they feel suddenly extremely low or negative just before the milk let down. This is called D-MER.

The intensity of D-MER also varies from woman to woman. In most cases, D-MER occurs in the first few weeks of postpartum when your body is already exhausted due to the childbirth process and constantly looking after the newborn. With time the condition recovers. But for some this D-MER lasts for months and only disappears after weaning.

[Read : Let Down Reflex And Breastfeeding]

Causes of Dysphoric Milk Ejection Reflex

Causes of D-MER

Unlike postpartum depression, D-MER or Dysphoric Milk Ejection Reflex is a physiological problem. It has nothing to do with your mental state. Two hormones that can be responsible for your D-MER distress are oxytocin and prolactin. These two hormones are released during breastfeeding. Prolactin causes the production of milk and oxytocin helps it to release or eject.

Oxytocin releases immediately when your baby starts sucking the areola or you pump your breast to store milk. But prolactin is released gradually. When Oxytocin is released, it inhibits the happy, mood-controlling hormone dopamine. When this drop of dopamine gets faster than normal it causes a brief flow of sad feelings in you. And this is when you become morose. This state can last for a few minutes until your dopamine levels go up again. Dopamine levels go up as soon as prolactin is released. So basically, the brief gap between oxytocin and prolactin release causes D-MER.

D-MER has something to do with ageing too. Most women who suffered from D-MER have this problem either with all their children or with their later children. By looking at the frequency of the D-MER cases nowadays, it seems like our hectic lifestyle and late pregnancy are somehow causing this problem.

Signs and Symptoms of D-MER in Breastfeeding Moms

Symptoms of D-MER

D-MER is marked with all sorts of sad feelings. D-MER lasts only for 2-3 minutes. But during these 2 to 3 you can go through various feelings like anxiety, anger, hopelessness, and depression. These feelings can again vary from woman to woman but broadly these are all unwanted and negative feelings. One mother, while explaining the feeling of D-MER, compares it with the creatures of Harry Potter named as dementors who suck the happiness out of one and left them in the abyss of negative thoughts.

According to the Australian Breastfeeding Association, some signs and symptoms through which you can classify D-MER are:

  • Sadness
  • Nervousness
  • Anxiousness
  • Hopelessness
  • Homesickness
  • Irritability
  • Emotional upset
  • Hollow feelings
  • Self-loathing
  • Angst
  • Paranoia
  • Dread
  • Suicidal thoughts

Due to the common signs and symptoms, D-MER is often mistaken for postpartum depression. But these two are different. Postpartum depression is a prolonged feeling of despair which has nothing to do with breastfeeding. On the other hand, D-MER will only occur when you breastfeed.

[Read : Postpartum Depression]

How is D-MER Diagnosed in Breastfeeding Moms?

There is not enough discussion about D-MER till now. As a result, many health care professionals also do not know what it is. So, there are not any diagnostic tests for D-MER as of now.

The diagnosis of D-MER entirely lies in observing the symptoms. If you are going through similar symptoms every time you express milk or breastfeed your baby, speak with your gynaecologist or midwife. You can also talk with a lactation consultant for more detailed information.

Top 9 Major Treatment Options For Dysphoric Milk Ejection Reflex

Treatment For Dysphoric Milk Ejection Reflex

There is no medicine to treat D-MER yet as research about this problem is very limited. As there is not enough awareness about D-MER, new moms feel guilt and stress because of their negative feelings while breastfeeding.

Most of the time, just recognizing the problem reduces the stress a lot. Some de-stressing technics helpful in D-MER are:

1. Skin-to-Skin Contact With the Baby

Skin-to-skin contact can lower your heart rates and cortisol levels. This will make you calm and positive at the same time create a strong bond between you and your baby.

2. Playing Soulful Music While Breastfeeding

Play your favorite songs or any soothing music to divert your mind from negative thoughts while breastfeeding.

3. Using a Comfortable Breastfeeding Position

Breastfeeding can get painful if you sit in one position bending for half an hour. Use a comfortable chair or take the help of the cushions and change the sides. It will help you towards a comfortable breastfeeding experience.

[Read : Top Breastfeeding Positions For Mom and Baby]

4. Getting a Massage

Tell your partner to massage your back and shoulders while you breastfeed so that you can relax a bit.

5. Meditation

Meditation will make your mind strong against any negative thinking. Take a few deep breaths and chant a mantra to get a positive vibe inside.

6. Seeking Help From Your Family

Share your problem with members of your family and friends. Stay close to the people you can trust. Sharing, many time, brings down the stress levels.

7. Putting a Hot Bag on Your Shoulders

This will relax your body and give you comfort.

8. Soothing Your Feet in Warm Water

This is very much helpful to get relief from stress. After the all-day running, you can take a hot water bath or put your feet in warm water to relax your body from stress.

9. Thinking About Yourself Too

Do not hesitate to think about your well-being. It is okay if you had to stop breastfeeding due to a severe problem of D-MER. Don’t take any guilt for that.

When to Consider Seeing a Doctor?

In spite of applying these stress-releasing techniques, if your problem is still not reducing then talk to your doctor. Some women find it helpful to take the antidepressants Wellbutrin or bupropion, and other generic medications. These can help by increasing dopamine levels. But as taking any medication for D-MER is not approved you should take it only if the doctor permits.

In today’s connected world, getting help with any problem is not so tough. You can google about your anxiety and condition anytime and find that you are not alone in feeling the same. So instead of blaming yourself seek help from others.

D-MER is a special condition marked with unhappy unwanted feelings of the mother during breastfeeding. If you are feeling the same problem this article is just for you.


1. How Long Does D-MER Last in Breastfeeding Moms?

D-MER in general occurs in the first few weeks of delivery. But for some women, it continues up to 3 months. And for some, it only disappears after the baby stops breastfeeding.

2. How Do You Know if You Have D-MER?

If you have D-MER, then you will feel a sudden wave of negativity as soon as you begin your breastfeeding or pumping routine. And these negative thoughts will only remain for a few minutes, and they will vanish. It is distinct from postpartum stress disorder in this way.

3. Should I Continue Breastfeeding With D-MER?

If you have a mild D-MER and can control your emotions or it is not affecting your mental health, then you can continue breastfeeding. But if you are having a severe D-MER and feel extremely fearful to breastfeed the next time then stop it for your health’s sake.

Read Also: Breastfeeding Pains and Discomfort

Aparna Hari,MBA in Marketing,P.G. Diploma in Human Resource Management from IGNOU Bachelor of Sciences (Home Science) from Nagarjuna University

Her experience in impactful writing combined with her background in Home Sciences makes Aparna the perfect candidate for content writing in the pregnancy and parenting niche.Read more.

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