Erica McClannahan, RN, BSN, IBCLC

 The endocrine system plays a major role in lactation. It stimulates the hypothalamus and pituitary gland to release oxytocin and prolactin hormones, which tell your body to produce and let down milk.  One of the magical wonders of breastfeeding is the benefits of oxytocin, as it is the hormone that brings feelings of love and comfort.  However, a newly discovered phenomenon called dysphoric milk ejection reflex (D-MER) is associated with brief, horrible feelings of depression during milk letdown.  While this has probably been occurring for hundreds of years, it is only now becoming something that experts are hearing about, and very little research has been done on the subject.  

How do you know if you have D-MER?

D-MER is associated with brief feelings of intense dread, sadness, depression, hopelessness, and anxiety that occurs only during the letdown phase (the initial 30-90 seconds of milk ejection) and quickly resolve.  Unlike postpartum depression, these feelings are fleeting and do not persist throughout the duration of the breastfeeding session or between feedings.  The symptoms can range from mild to severe - some women even report momentary suicidal thoughts.  Generally, with this condition, all negative thoughts and feelings completely disappear after a few minutes. 

What causes these negative emotions?

Hormones can be tricky to study and quantify as it is difficult to track their exact levels in the brain.  Experts do, however, believe that the wave of negative emotions is caused by a sudden drop in the hormone dopamine.  Dopamine and prolactin are linked - as one rises, the other drops to keep each other in check.  It’s possible that the letdown of milk causes a brief, drastic drop in dopamine leading to these awful feelings.  It’s important to know that this phenomenon is physiological, not psychological, so it is not in your head or something you can control.  

How do you get rid of D-MER?

No effective treatment plan has been brought to light yet… but hopefully, with new research, doctors can find a solution to this troubling anomaly to help mothers.  Many women say they find it comforting to know that there is a theory behind it and that others are out there that experience it too!  Some women say that having a piece of chocolate, distracting themselves with a happy tv show, or talking to a loved one during a letdown helps them cope during that time of discomfort.  The occurrence of D-MER tends to drop with time, it may resolve on its own after 3-6 months of breastfeeding, but for others, it continues until weaning.  Weaning is always an option as these episodes are only linked to lactation and will resolve with cessation of breastfeeding. 

If you or someone you know struggles with unhappy feelings while breastfeeding, you are not alone!  With everything on your plate as a mom, it can be hard to cope with the intense emotional fluctuations that hormonal shifts can bring.  We wish to empower you to talk about how this journey makes you feel and seek help as needed.  Your emotional well-being is a priority; we are here to support you!