What is D-MER
Dysphoric Milk Ejection Reflex, or D-MER, is a condition experienced by some breastfeeding mothers characterized by sudden negative emotions, such as depression, anxiety or irritability right before the let-down of milk and lasting approximately 30 seconds - 2 minutes.
D-MER occurs becaues of an inappropriate drop in dopamine levels. When milk is produced, dopamine levels naturally lower to allow for prolactin levels to rise in order to make more milk. Normally, this goes unnoticed by the mother. However, in the case of mother's experiencing D-MER, the dopamine level falls inappropriately causing the immediate, brief wave of dysphoria until the levels stabilize. It can happen before any let-down including, nursing, pumping or random let-downs.
D-MER is not a psychological response, postpartum depression or nursing aversion.
How it Feels
D-MER can vary in intensity from mild to severe. One mother with severe D-MER described it as such:
Starting about 2 weeks after I gave birth, I started experiencing horrible depression every time I breastfed my daughter. Right before my milk would let-down I would completely break down into tears. Not just a few tears, but hard, shoulder-shaking sobbing. I felt like my world was coming down around me. I began to hate breastfeeding and was worried I couldn't continue any longer. During the middle of the night feedings, I would have to wake my husband up to sit with me because I was too afraid to breastfeed on my own.
Coping with D-MER
The most effective treatment for D-MER is education and awareness. There is currently no medication for D-MER. Once the mother understands what she is going through, it can become much more tolerable. The mother above did continue breastfeeding and has this to say about it:
It eventually got to the point where I felt like I couldn't continue breastfeeding. Before I made the decision, I decided to do some research which is when I learned about dysphoric milk ejection reflex. Once I knew what I was going through it became much more tolerable. Soon, the sobbing subsided and the extreme depression I was experiencing at every feeding went away. I still experience anxiety at many feedings, but I know that it will pass after just a minute or two and we have been able to continue to exclusively breastfeed.