Week Five: Answers to your Questions about Dysphoric Milk Ejection Reflex
Hey breastfeeding mamas -- have you ever felt a rush of intense negative emotions just prior to your milk letdown? This feeling might have felt like a slight fog or perhaps it was a heavy, depressed feeling in your chest or pit of the stomach. You may have worried how you could possibly feel this during such a special and intimate moment with your child. If this has been your experience with breastfeeding, you already know the bad news (this sucks A LOT), so I’ll skip ahead to the good news. This is a real thing, with a name, and you are not alone.
Dysphoric Milk Ejection Reflex, also referred to as D-MER, is characterized by a wave of negative emotion just prior to milk letdown. Breastfeeding mothers may experience this rush of negative emotions around 30-90 seconds prior to milk release. These feelings usually dissipate, between several seconds to a couple minutes after letdown, but return prior to another milk letdown. Moms who have experienced D-MER have described it as sadness, dread, anxiety, hollow feelings, irritability, hopelessness or angst. The feelings differ and range in intensity. One mother with mild D-MER may experience slight worry or even a feeling of homesickness. Another with more severe symptoms may feel intense sadness, anger, dread, or fear leading to thoughts of self-harm or suicidal ideation. These feelings are usually brief, and it is rare that women act on their catastrophic thoughts.
Experts believe that D-MER is related to the relationship between the three main hormones involved in milk production: oxytocin; prolactin; and dopamine. Oxytocin is released when nipples are stimulated, breasts are full, baby latches, or even at baby's scheduled feeding time. This helps trigger the production of prolactin, which peaks at the beginning of a feed. However, in order for prolactin to peak, dopamine must drop. Some women may be more sensitive to this sudden drop, or their dopamine may drop more than what is necessary to stimulate milk flow. According to D-MER.org, some mothers may experience this due to an environmental effect, a nutritional deficiency, a breakdown in normal hormonal activity with aging, increased sensitivity to a normal drop in dopamine, dopamine receptor mutation, a predisposition to abnormal dopamine activity, or some other unknown cause.
Most mothers notice the onset of D-MER within the first couple weeks of breastfeeding, and for many it will subside by the time the baby is around three months old. For others D-MER remains until weaning. In contrast to a mother who is experiencing a postpartum mood or anxiety disorder, a mother with D-MER generally feels okay except just before her milk starts to flow. It is possible that a mother who experiences D-MER may also struggle with postpartum depression or anxiety, but they are separate issues. It is important to distinguish one from the other in order to receive proper and effective treatment. Some mothers with D-MER may need to consider professional support in order to more effectively manage their D-MER.
Many women find it helpful to know that these feelings are due to a natural dance of the hormones that make breastfeeding work. They can then practice positive visualization techniques to tolerate and work through the negative feelings. Mothers without this information might consider discontinuing breastfeeding because they are confused by and afraid of what they are experiencing. Of course, deciding whether or not to breastfeed is a personal decision, but it is best when that decision comes from a position of knowledge as opposed to a state of fear. Often, just knowing what D-MER is can provide the comfort and support that is needed and the reassurance that these feelings will pass shortly.
Hang in there, beauties, and for more information, please visit D-MER.org.