One of the more mysterious and distressing symptoms during the postpartum and breastfeeding journey is rarely mentioned yet far more common than you'd imagine.
Dysphoric Milk Ejection Reflex (D-MER) shares many common features with other perinatal mood symptoms, such as anxiety, depression, sadness, and melancholy. You may experience these intense negative emotions specifically during milk ejection (commonly known as letdown), starting as early as the first weeks of lactation. These emotions can come on quickly and overwhelmingly but retreat just as fast. Lasting anywhere from a few seconds to a few minutes, you might misinterpret these intense emotions as Postpartum Depression, Panic Disorder, or simply not bonding well with your baby.
Like other perinatal mood disorders, D-MER symptoms tend to diminish over time, but they may persist throughout your breastfeeding or pumping journey. The severity of these symptoms often decreases as you become more informed about the physiological aspects of D-MER and develop coping skills to manage the specific emotions you're feeling. This is similar to how education and support can alleviate other perinatal mood issues.
How to Manage Symptoms
Coping skills for D-MER are similar to those for managing anxiety or depression: relaxation techniques, self-care, awareness, education, and social support are key.
The first step is identifying whether what you're experiencing is D-MER. Make sure to rule out more serious conditions like postpartum psychosis or other health issues. Once you've confirmed it's D-MER, recognize when it's happening and try to identify the main emotion(s) running through your body.
Belly Breathing can be extremely helpful during those seconds or minutes when you’re experiencing physical symptoms.
Grounding Techniques: Grab an ice pack and apply it to your neck or face before starting your breastfeeding or pumping session.
Distraction: In the short term, distracting yourself with a book, music, a podcast, or a game can help while symptoms are happening. However, long-term reliance on distraction can lead to more serious mental health concerns.
General Self-Care: Afterward, make sure you’re getting as much restful sleep as possible, staying hydrated, and eating healthy meals or snacks.
Causes of D-MER
Both D-MER and general perinatal mood symptoms are influenced by biological and hormonal changes, as well as external factors. D-MER is linked to rapid drops in dopamine during breastfeeding, which can trigger negative emotional sensations. Hormonal fluctuations involving dopamine, oxytocin, and prolactin are also linked to other perinatal mood disorders. Genetic and situational factors may influence how D-MER and broader mood symptoms are expressed.
External factors like lack of support, sleep deprivation, and poor self-care can worsen symptoms as well.
Impact on Breastfeeding Self-Efficacy and Maternal Role
The intense emotional distress caused by D-MER can reduce your breastfeeding confidence and increase overall stress. This is similar to how perinatal mood symptoms can affect your sense of efficacy and self-worth. Feelings of guilt, shame, and perceived failure are common in both D-MER and other perinatal mood disorders, which might lead you to consider reducing or stopping breastfeeding; while this is a completely personal choice these symptoms can be decreased intensity and will eventually recede.
Support and Awareness
As with other perinatal mood conditions, social support from peers and healthcare providers is crucial for managing D-MER. Support groups and open discussions can help reduce isolation and guilt. Often mothers don't bring this up in appoints due to belief that Raising awareness among healthcare professionals about D-MER, along with other perinatal mood disorders, is essential to provide you with the support you need.
Cessation of Breastfeeding
If you decide to stop or reduce breastfeeding due to D-MER, your decision will likely be influenced by emotional complexities similar to those experienced in other perinatal mood disorders. While you may feel relief from the symptoms, you might also experience sadness over ending the breastfeeding relationship.
It’s important to note that any rapid decrease in milk supply can also cause a significant increase in depressive and anxious symptoms. You might feel like you’re having a relapse in perinatal mood disorders during this time.
While D-MER can be incredibly intense and fear-inducing, it is manageable with the appropriate steps. Know that you are not in this alone and with knowledge, support, and self-care you will be okay!
What is Dysphoric Milk Ejection Reflex (D-MER) Symptoms and Timing:
Dysphoric Milk Ejection Reflex (D-MER) shares many common features with other perinatal mood symptoms, such as anxiety, depression, sadness, and melancholy. Distressingly, these intense negative emotions occur specifically during milk ejection (more commonly know as let down) and beginning as early as the first weeks of lactation. They also present themselves quickly and overwhelmingly, and can retreat just as quickly. Last a few seconds to a few minutes, to the unknown mother they can misinterpret these intense emotions to Postpartum Depression, Panic disorder and generally not bonding well with baby.
Like other perinatal mood disorders, D-MER symptoms often diminish over time but can persist throughout the breastfeeding/pumping period. The severity of symptoms tends to decrease as mothers become more informed about the physiological aspects of D-MER and find coping skills for their specific emotions arising, similar to the way education and support can mitigate other perinatal mood issues.
How to Manage Symptoms:
Coping skills for D-MER are similar to any other coping skills for anxiety/depression: relaxation skills, self care, awareness, education, and social support are key to managing D-MER.
The difference and first steps lie in detection first, Is this D-MER? Making sure there isn't more serious illness underneath such as postpartum psychosis, or other health issues. Once that has been established, recognize when it is happening and identify the main emotion(s) running through your body.
Belly Breathing can be extremely useful for the seconds/minutes that you are experiencing the physical symptoms.
Grounding Techniques: Grab ice pack for you neck/face before starting breastfeeding/pumping session.
Distraction: this is a short term solution only; reading a book, listening to music/podcast or playing a game can be use distraction while symptoms are currently happening. Long term distraction of symptoms can lead to other more serious mental health/health concerns.
General self care afterwards: ensure that you are gettin as much restful sleep as possible, stay hydrated and eat healthy meals/snacks.
Causes of D-MER:
Both D-MER and general perinatal mood symptoms are influenced by biological/hormonal changes and external factors. D-MER is linked to rapid drops in dopamine during breastfeeding, leading to negative emotional sensations. Similarly, hormonal fluctuations, including those of dopamine, oxytocin, and prolactin, are involved in other perinatal mood disorders. Genetic and situational factors can affect the expression of both D-MER and broader mood symptoms.
External factors such as lack of support, decrease in sleep/rest and poor self care and exacerbate symptoms as well.
Impact on Breastfeeding Self-Efficacy and Maternal Role:
The intense emotional distress from D-MER can lower breastfeeding confidence and increase overall stress for the mother, similar to how perinatal mood symptoms can impact a mother's sense of efficacy and self-worth. Feelings of guilt, shame, and perceived failure are common in both D-MER and other perinatal mood disorders, often leading mothers to consider reducing or stopping breastfeeding.
Support and Awareness:
Just as with other perinatal mood conditions, social support from peers and healthcare providers is crucial for managing D-MER. Support groups and open discussions can help reduce isolation and guilt. Increasing awareness among health professionals about D-MER, as well as general perinatal mood disorders, is essential for providing effective support.
Cessation of Breastfeeding:
Decisions to stop or reduce breastfeeding due to D-MER are often influenced by similar emotional complexities experienced in other perinatal mood disorders. While relief from symptoms may be achieved, there is often sadness associated with ending the breastfeeding relationship.
Making sure to notes that any decrease in milk supply, especially if rapid, can ALSO cause a significant increase in depressive and anxious symptoms. Often leading women to feel as if they are experecing a relapse with perinatal mood disorders.
Discussion on D-MER Research:
D-MER, like other perinatal mood symptoms, is likely caused by hormonal fluctuations. Continued research is needed to understand the prevention, management, and contributing factors for both D-MER and other perinatal mood disorders. Strategies such as mindfulness and support from healthcare teams are beneficial for managing symptoms across both conditions.
Limitations and Conclusion:
The research on D-MER, like that for other perinatal mood disorders, is limited, particularly in diverse populations. Most studies focus on high-income countries, highlighting the need for broader research to understand D-MER’s impacts globally. Future studies should explore prevention and management techniques and consider the cultural and regional variations of both D-MER and perinatal mood symptoms.
Deif, R., Burch, E. M., Azar, J., Yonis, N., Abou Gabal, M., El Kramani, N., & DakhlAllah, D. (2021). Dysphoric milk ejection reflex: The psychoneurobiology of the breastfeeding experience. Frontiers in Global Women's Health, 2. https://doi.org/10.3389/fgwh.2021.669826
Herr, S. L., Devido, J., & Demirci, J. R. (2024). Dysphoric milk ejection reflex in human lactation: An integrative literature review. Journal Name, 40(2), .
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