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Sadness & Breastfeeding: What’s D-MER?

Sadness & Breastfeeding: What’s D-MER?

Posted by Krystal Duhaney, RN, BSN, IBCLC on Feb 18th 2021

Breastfeeding mamas have heard a lot about oxytocin, fondly referred to as the love hormone. This hormone helps your breasts to release milk and also to bond with your baby. The release of oxytocin usually brings on feelings of happiness, contentment, and love.

This is not the reality that some breastfeeding moms face. Instead of feeling blissful, some women feel anxious or depressed. Although there are some similarities in how it can make you feel, this is not postpartum depression or anxiety. It is a lesser known condition called D-MER, or dysphoric milk ejection reflux.

Why don’t I feel happy during letdown?

Dysphoric milk ejection reflux, or D-MER, causes lactating women to experience a state of dysphoria, or unhappiness, for 30 seconds to a few mintutes upon letdown. Intense negative feelings of varying severity are the most common signs.

Little is known about D-MER and it often goes undiagnosed or misdiagnosed as postpartum depression or anxiety. It’s possible to have either of these conditions along with D-MER, but it’s important to know that they are not interchangeable.

According to the Australian Breastfeeding Association, these are the most common feelings associated with D-MER:

  • Hollow feelings in the stomach
  • Anxiety
  • Sadness
  • Dread
  • Introspectiveness
  • Nervousness
  • Anxiousness
  • Emotional upset
  • Angst
  • Irritability
  • Hopelessness
  • Something in the pit of the stomach

Is there anything that causes D-MER?

As mentioned above, the hormones released upon letdown are thought to be the cause of D-MER.

Oxytocin is the first hormone that is released. When your baby begins to suckle at the breast, or you begin to pump, oxytocin is released for about 10 minutes. Prolactin, the milk-producing hormone, is then released for about 20 minutes after your nursing or pumping session starts. Dopamine, the hormone that boosts and stabilizes your mood, is the third hormone that comes into play. The main job of dopamine is to boost and stablize mood.

Normally these hormones produce all of the fuzzy, happy feelings that we associate with breastfeeding. For a mother with D-MER, the hormones don’t interact the way they should. Oxytocin causes a drop in dopamine levels, which normally is fine and not noticeable.

With D-MER, the rise in oxytocin causes dopamine to drop quickly causing the flood of negative emotions. Once your prolactin levels increase, your dopamine levels go back to normal, which is why many women only experience these feelings temporarily during feeding or pumping.

How long will D-MER last?

The duration of D-MER differs from person to person. Some moms only experience D-MER for a few days while others experience it for their entire breastfeeding period.

Many moms say that the severity of their symptoms does decrease as time goes on.

Are there ways to treat D-MER?

D-MER is a relatively new condition in the medical world. Not a lot of research has been done but there is more being conducted to help us fully understand the specifics surrounding D-MER.

Being aware that you have D-MER is often the first step in treatment. Knowing that your body is having a physiological reaction to your milk being released can help to cope.

Some moms have reported that lifestyle and diet changes have improved their condition. Limiting caffeine intake, reducing stress, staying hydrated, and making sleep a priority can help. Getting exercise and practicing mindfulness may also improve your symptoms.

If you are experiencing severe symprtoms of D-MER, please talk to your healthcare provider about herbal supplements or medications that could help.

Final Thoughts

D-MER is a real condition affecting a small percentage of lactating women. Although it hasn’t officially been around for very long, it is gaining awareness and more research is being done to understand it. Feeling these intense and heavy negative emotions during letdown is not normal and you’re not alone in feeling it.

While treatment options are still being discovered, we encourage you to talk to someone about what you are experiencing. Your healthcare provider, an International Board Certified Lactation Consultant (IBCLC), or Certified Lactation Consultant (CLC) can give you guidance on navigating these feelings and discuss options for your next step. Schedule your virtual consultation with an IBCLC or CLC from the Milky Mama team today.