Dysphoric Milk Ejection Reflex (D-MER): When breastfeeding makes you anxious

Most women imagine that breastfeeding will fill them with warm and fuzzy feelings as they gaze down lovingly at their feeding baby.

But instead, women with Dysphoric Milk Ejection Reflex (D-MER) can find themselves filled with an overwhelming feeling of panic, sadness or dread as they breastfeed their babies.

Jess says, “I’d been breastfeeding my daughter for a few months. No supply issues and no pain. Out of nowhere, feeding her suddenly repulsed me. I felt so irritable and restless with each feed. It made my skin crawl, like nails scraping down a blackboard. I had breastfed my first baby and didn’t experience this. It was so sudden – I wondered whether I was suffering from depression, even though life was good, and I felt happy in general.”

Thankfully, D-MER is fairly rare. But this little-known condition can ruin the breastfeeding experience for women who suffer from it.  

What is D-MER?

D (Dysphoric) MER (Milk Ejection Reflex).

D-MER is a condition that causes a feeling of dysphoria, right before letdown (when the breasts release milk). Usually the negative feelings will only last for a few minutes. However symptoms can range from mild to severe, leading some women to wean their babies from the breast in extreme cases.

What causes D-MER?

D-Mer is not an ‘emotional’ response to breastfeeding, it isn’t caused by anxiety for instance, and it’s not related to postnatal depression or due to some underlying repulsion or inhibitions about breastfeeding.  It can happen as you breastfeed, express, or have spontaneous letdowns at any time. 

There is recognised link between hormonal shifts and D-MER. Research suggests that an inappropriate drop in dopamine (a ‘feel good’ chemical in the brain) during the letdown of milk is to blame for D-MER and its feelings of negativity.

The website offers an explanation: Milk release (your letdown) itself isn’t caused by dopamine dropping, but a rise in oxytocin. Normally, dopamine inhibits prolactin, (the milk production hormone), so dopamine levels need to drop for prolactin levels to rise to make more milk. Although most mothers won’t notice this at all, in D-Mer Mums, an inappropriate dopamine drop causes a wave of negative emotions that lasts until levels restabilise after prolactin begins to rise.

What does D-MER feel like?

D-MER can feel different for different women and has been labelled either despondency D-Mer, anxiety D-Mer or agitation D-Mer - and it can vary on a spectrum of severity, from mild or moderate to severe.

Women describe feelings of:

  • Anxiety
  • Dread
  • Irritability
  • Hopelessness
  • Negative thoughts
  • Sadness
  • Anger

Getting help

If you think you may have D-MER, it’s important to seek help from a health professional.

For some women, triggers such as stress, caffeine, dehydration, and lack of sleep can make symptoms worse.  It can be helpful to chart when D-Mer occurs and see if there are any of these contributing factors.

Jess says, “after speaking with a health professional and learning of D-MER, I tried to push through by distracting myself during feeds and limiting my caffeine intake. It got better with time”

Some women find distraction helps them cope with the feelings of D-MER e.g., eating, watching TV or scrolling through their phone while breastfeeding.

For severe cases of D-MER, medication may also be an option.