Feeling Down with Let Down? Feeling discomfort associated with your milk letting down may be more common than you think. This phenomenon is called Dysphoric Milk Ejection Reflex or “D-MER”
What is D-MER?
Dysphoric Milk Ejection Reflex Or D-MER is a “condition affecting lactating women that is characterized by an abrupt dysphoria, or negative emotions, that occur just before milk release and continuing not more than a few minutes.” (Sadness When Breastfeeding – D-MER.org). D-MER is not postpartum depression or anxiety, nor is it a general dislike of breastfeeding or an aversion to feeding and the breast. Recent studies tell us that a drop in Dopamine may be blamed for these uncomfortable feelings. D-Mer can be identified by:
- A wave of negative emotion about 30-90 seconds before your milk lets down
- Lasting around 30 seconds to 2 minutes
- Negative feelings usually resolve once let down is complete and baby starts swallowing
- Like any reflex, the feelings can repeat with additional let downs
What does Dysphoric Milk Ejection Reflex feel like?
It is important to understand that D-MER is not a depression, anxiety, or other psychological response. The Dysphoric feelings associated with the milk let-down are a physiological response to the increase in Oxytocin, creating an intense drop in Dopamine. Some of the feelings that parents experiencing D-MER have shared are:
- Sadness
- Dread
- Anxiousness
- Irritability
- Nervousness
- Hopelessness
- Anger
- Aversion to food or a normally enjoyable activity
- General negative emotion
D-MER is a spectrum, both in intensity and symptoms or feelings. Not every parent experiencing this condition is going to feel symptoms in the same way.
Is D-MER Treatable?
Currently, there is no recommended treatment for Dysphoric Milk Ejection Reflex. One of the most effective ways to ease the discomfort is education and understanding why and how this condition occurs. Parents can then understand that it is not their fault or something they are doing wrong and that it will not last forever. Some things that may be helpful for getting through these hard periods of time are:
- Practice deep breathing exercises
- Distract yourself – many parents repeat affirmations, watch a television show or movie, or even call or talk to a friend or family member.
- Drink an ice-cold drink before and during let down
- Keep time between nursing and pumping to a minimum to help avoid spontaneous let downs
- Keep open communication with your support partners about your feelings
- Discuss medications and supplements with your healthcare provider. Some studies show that Vitamin D, Magnesium, and Vitamin B may help.
- Track your symptoms in a journal to help you understand what helps or does not work and to discuss with your health care professionals.
Equally, if not more important than all these things, is to take care of yourself. If you are already feeling down, D-MER can make you feel worse. Doing things that help you feel good will always be helpful. Try to make sure that you have a relaxing and comfortable environment to feed and pump in, rest when you can, stay hydrated and make sure you are eating. Isolation, lack of adequate carbohydrates, hormonal birth control, hormonal fluctuations associated with menstruation, and an uncomfortable environment may contribute to the intensity of the dysphoria or symptoms.
D-MER is not Postpartum Depression
Is D-MER caused by depression and anxiety? From what has been studied, we don’t think so. Parents may experience depression and anxiety along with D-MER, but they are not the same nor do they always present together. Depression and Anxiety are common among new parents, both Postpartum and the temporary “Baby Blues”. The difference between these mental health conditions and D-MER is that with depression and anxiety, the symptoms are experienced frequently or all of the time – regardless of what you are doing in that moment. Dysphoric Milk Ejection Reflex is specific to the moment that milk travels through the ducts, or your Let-Down, and the feelings are resolved with the end of the letdown.
Please reach out for help if you are experiencing any of the symptoms listed in this article or those associated with depression or anxiety. Many of the mental health medications available today are compatible with breastfeeding and you can speak to your health care provider about the best option for you. You may also find that therapy is helpful in treatment and management of postpartum depression or anxiety, as well as D-MER.
Resources:
Sadness When Breastfeeding – D-MER.org
Postpartum Support International offers a hotline accessible to parents by phone or text:
1-800-944-4773 (4PPD) #1 En Español or #2 English
Text in English: 800-944-4773
Text en Español: 971-203-7773
NAMI HelpLine | NAMI: National Alliance on Mental Illness
Aryn
Aryn is a Certified Lactation Counselor on the Kiinde Lactation team. She is also a mother of two, writer, and maternal mental health advocate.
