Dysphoric Milk Ejection Reflex, or D-MER, is a condition affecting some lactating individuals, characterized by sudden negative emotions just before or during the milk ejection reflex. This phenomenon is a physiological response, stemming from hormonal shifts in the body, rather than a psychological or emotional reaction to breastfeeding itself. It is a distinct physical experience that occurs involuntarily.
Understanding D-MER
D-MER manifests as a wave of unpleasant emotional and sometimes physical sensations that arise seconds before milk let-down and subside within 30 seconds to two minutes after milk begins to flow. Individuals describe feelings such as dread, anxiety, sadness, irritability, anger, or a sinking sensation in the stomach. These feelings are involuntary and directly tied to the milk ejection reflex, differentiating D-MER from general anxiety or postpartum depression.
The underlying mechanism of D-MER involves a sudden drop in dopamine levels in the brain, which occurs as oxytocin, a hormone that triggers milk release, increases during let-down. While oxytocin rises, a corresponding decrease in dopamine, a neurotransmitter associated with pleasure and well-being, contributes to these dysphoric feelings. This physiological shift is temporary, and the negative emotions resolve quickly once the milk flow is established.
The Typical Timeline of D-MER
D-MER begins shortly after childbirth, coinciding with the establishment of lactation, though it can sometimes emerge later in the breastfeeding journey. The duration of D-MER varies significantly among individuals. For many, the symptoms may lessen in intensity or resolve completely within the first three months postpartum. Other individuals might experience a reduction in symptoms over several months, with improvement as their baby grows older.
While some individuals find their D-MER resolves within weeks or a few months, others may experience it for the entire duration of their breastfeeding period. The intensity of the dysphoric feelings can also fluctuate over time, sometimes being milder on certain days or with specific feedings. This variability means there isn’t a single, fixed timeline for when D-MER will go away.
Coping with D-MER
Managing D-MER symptoms involves practical, non-pharmacological approaches focused on self-care and distraction. Engaging in activities that divert attention during let-down, such as listening to music, watching television, or reading, are beneficial. Focusing on deep breathing exercises or practicing mindfulness during the onset of symptoms can also help manage the temporary discomfort.
Maintaining adequate hydration and ensuring consistent nutrition can support overall well-being and may lessen the impact of D-MER. Creating a calm and comfortable environment for breastfeeding can contribute to a more positive experience. Acknowledging that these feelings are a physiological reflex and not a personal failing can provide a sense of validation and reduce distress.
When to Seek Professional Guidance
It is advisable to consult a healthcare professional if D-MER symptoms are severe, significantly impact mental health, or interfere with the ability to breastfeed. Persistent feelings of hopelessness, severe anxiety, or thoughts of self-harm warrant immediate professional attention. A lactation consultant can offer specialized support and strategies tailored to managing D-MER. A doctor or mental health professional can assess overall well-being and provide guidance for more challenging cases.