Feeling a sudden wave of intense anger, dread, or agitation when milk begins to flow during pumping or nursing is a recognized physiological phenomenon. This confusing and often upsetting experience is not a reflection of your feelings about motherhood or your baby. These negative emotions are real, and they are temporary. They are directly tied to the mechanics of milk expression, meaning they cannot be consciously controlled or simply ignored.
Defining Dysphoric Milk Ejection Reflex
The specific condition is called Dysphoric Milk Ejection Reflex, or D-MER. D-MER is a physiological reflex characterized by a spectrum of negative emotions, including anxiety, sadness, hopelessness, and anger. These feelings occur just before the milk ejection reflex, or “letdown,” and are a direct response to a chemical shift in the body, not psychological in origin.
The negative emotions associated with D-MER come on suddenly and are intensely felt. These feelings are short-lived, typically lasting anywhere from 30 seconds to a few minutes. Once the letdown is established and milk is actively flowing, the dysphoria usually vanishes as quickly as it appeared.
D-MER is distinct from general stress, postpartum depression (PPD), or postpartum anxiety (PPA). The defining feature is that the feelings are brief and tied exclusively to the milk letdown reflex. If negative emotions persist outside of the few minutes surrounding milk expression, consult a healthcare provider to check for a mood disorder.
The Hormonal Basis of the Feeling
The leading scientific theory explaining D-MER points to a temporary disruption in the neurotransmitter dopamine. Dopamine is a chemical associated with reward, pleasure, and stabilized mood. For milk to be produced and released, the body needs a balance of several hormones, primarily prolactin for milk synthesis and oxytocin for the milk ejection reflex.
The process requires an increase in prolactin for milk production. Since dopamine naturally suppresses prolactin, the brain must temporarily reduce its dopamine output to allow prolactin levels to rise during nursing or pumping. For most people, this dip in dopamine is minor and goes unnoticed.
In individuals with D-MER, it is hypothesized that the dopamine level drops too quickly or too severely in the moments leading up to the letdown. This abrupt, transient decrease in the mood-regulating chemical causes the sudden onset of dysphoria, experienced as feelings like anger, dread, or anxiety. Once the letdown is complete and the initial hormonal surge passes, the dopamine level quickly stabilizes, and the negative feelings resolve.
Practical Ways to Cope and Manage D-MER
While there is no single treatment for D-MER, several strategies can help manage the symptoms. Simple lifestyle adjustments are often the first step in mitigating the severity of the negative feelings.
Lifestyle Adjustments
- Ensure adequate hydration.
- Reduce or eliminate caffeine intake, as stimulants can exacerbate symptoms.
- Prioritize sleep.
- Manage overall stress levels, as lack of rest and high stress can worsen the reflex.
Distraction Techniques
Distraction techniques are useful because the emotional wave is brief. Distracting your mind by watching a television show, scrolling on your phone, or reading a book during the letdown can help bypass the negative sensation. Acknowledging that the feeling is a quick, physical reflex that will pass in a minute or two can also provide a sense of control. Some people find relief by drinking a glass of cold water at the start of the session.
If D-MER is persistent or severe, or if the dysphoria extends beyond the brief window of the letdown, seek professional support. A lactation consultant or healthcare provider can offer personalized coping strategies and help distinguish D-MER from other mood disorders. In severe cases, a doctor may discuss specific medication options that impact dopamine levels, but these are typically reserved for when conservative measures are insufficient.