Dysphoric Milk Ejection Reflex: Why Breastfeeding Can Make Some New Parents Miserable

By Published On: September 7th, 2023

This little-known condition can have a huge impact on postpartum mental health.

Nicole Evry, a psychotherapist and mother of two in New York, tells me her experience with Dysphoric Milk Ejection Reflex (D-MER) felt like intense homesickness. “It reminded me of being away for sleepaway camp for the first time: insecure, scared, and alone.” But this feeling wasn’t caused by being away from her family or home; in fact, quite the opposite—it was caused by nursing her new baby.

“Right before a letdown, I feel an intense feeling of sadness, usually on the verge of tears,” says Jade, a mother of four living in San Juan, Puerto Rico. Evry and Jade are among the estimated 5-9% of breastfeeding parents who experience D-MER. While conditions like postpartum depression are becoming more normalized in mainstream culture, many people still haven’t even heard of D-MER, which can make those experiencing it feel alone and isolated.

What is Dysphoric Milk Ejection Reflex (D-MER)?

D-MER is a condition caused by fluctuating hormone levels that leads to feelings of intense sadness during the let-down portion of breastfeeding. “The condition is described as the sudden onset of negative emotions—such as anxiety or tearfulness—that occurs just before a lactating person experiences a let-down or milk ejection reflex while nursing or expressing milk,” says Andrea Braden, FACOG, IBCLC, a board-certified OB-GYN breastfeeding medicine specialist (and mom of five) practicing in Decatur, Georiga. “Symptoms usually resolve once the milk begins to flow, lasting no more than two minutes. “

One 2023 study described D-MER as a “dysphoria,” meaning a state of unease or generalized dissatisfaction with life.

In the early days with a newborn, breastfeeding parents feed their babies as many as eight to 12 (or more) times per day, at a cadence of every two to three hours—the clock to the next feed starts at the beginning of the previous feeding (something I didn’t know until I had a baby and started breastfeeding myself). That means that even if the intense emotions are short-lived, you’re experiencing them around the clock, with sometimes only an hour or so in between, which, coupled with the exhaustion of new parenthood, can take a toll on mental health.

What Causes D-MER?

To understand D-MER, knowing what controls the milk ejection reflex is important. As you breastfeed, your body releases prolactin, a hormone responsible for breast milk production, and oxytocin, which signals milk to flow once the baby latches or you begin to pump. The rise in oxytocin plummets dopamine levels, a “feel-good” hormone.

“The cause is not well-defined,” Dr. Braden explains, “although health care providers believe the feelings of unhappiness or other negative emotions in a person with D-MER is due to the rapid decrease in dopamine that happens when their oxytocin levels spike during milk expression.”

What Does D-MER Feel Like?

D-MER can manifest in many ways, including intense anxiety, crying, sadness, loneliness, helplessness, dread, or anger. Taylor Gunter, a mom of one child living in Nixa, Missouri, experienced D-MER with her son, who is now 9 years old, but she says the feelings are still fresh in her head. “It’s truly the worst I’ve ever felt,” she says, “ and I’ve been diagnosed with major depressive disorder before and have multiple anxiety disorders.” She adds that seeing the disorder get more support and visibility is exciting, as she was never officially diagnosed but did find a support group online. “I always wished I could have had that great, happy, bonding moment like the other moms. Instead, all of my letdowns filled me with this awful dread. I still managed to breastfeed for a year, but D-MER made that very difficult.”

I was fortunate not to experience D-MER, but when I would breastfeed my son in the wee hours, I’d imagine people going about their days in Australia so I didn’t feel like the only person in the world awake. Adding D-MER to an experience that can sometimes already feel isolating and lonely can be incredibly intense.

“The first week or so of breastfeeding was torture, with the pain, hormones, and D-MER, it was a lot,” Jade says. “I almost gave up completely because I would be in tears, pain, and [feeling] immense sadness. After two days, I was like no, I cannot do this.” Jade pumped to keep up her milk supply instead of breastfeeding until the soreness subsided and her hormones leveled out a bit. Both Evry and Jade note that the intensity of the negative feelings lessened while pumping, though this isn’t the case for every person.

How Do You Stop Dysphoric Milk Ejection Reflex?

There’s no known cure for D-MER, and research and case reports are lacking. According to the 2023 study mentioned above, D-MER is “only recently gaining recognition in the academic literature and may have important implications for breastfeeding continuation, differential diagnosis, and perinatal mental health.” The hope is that as more research comes out, there will be more information on preventing or easing the symptoms of D-MER.

While, at this time, D-MER can’t be stopped, the condition can be somewhat managed. Jade mentions that it helped her to put on a funny show right before nursing, have her husband tickle her feet, or eat a treat as she began her milk release.

“If I was nursing, drinking a cold coconut water with a straw alongside a distraction in the background like a familiar TV show helped immensely,” Evry says. “In the moment, I would try to remind myself that [the feeling] passes quickly.” She adds that she found it better to be alone with the baby in a room because it was hard to respond if others were trying to chat with her while it was happening.

Jessica Anderson, MA, IBCLC, CLC, a lactation consultant in Maryland and wearable pump expert with Tommee Tippee, says that her best advice for dealing with D-MER is to reach out to a lactation consultant who can assess if there is anything that can be done to reduce the discomfort and intensity of the symptoms experienced, adding that it typically affects those who are sensitive to dopamine shifts. “If you are someone who perceives the drop in dopamine, you may experience negative thoughts and feelings when you have a letdown. A common thing we look at is reducing harsh nipple stimulation when pumping, which seems to exacerbate issues with D-MER,” she says.

It can also be helpful to write down your symptoms as they happen. “This will help you understand the timing of the condition so that you can anticipate and manage the symptoms,” Dr. Braden says. “Some people find mindfulness and meditation to be helpful at the start of a feed. Others may find comfort in listening to their favorite music or skin-to-skin contact with their infant.”

When Is It Time to Wean?

Some may find that D-MER feels so intense that they decide not to continue breastfeeding (which is completely valid). However, it’s important not to go cold turkey in this case. “If you find that your symptoms are difficult to manage on your own or that your D-MER is so severe that you want to wean earlier than planned, seek professional help from a lactation consultant or breastfeeding medicine specialist immediately. Rapid weaning from breast/chestfeeding or pumping may worsen mood disorders and should be done gradually under the supervision of a lactation professional,” Dr. Braden says.

All the parents I spoke to for this story mentioned how helpful it was to know that the feelings they experienced—D-MER—had a name that wasn’t specific to them or “all in their head.” Finding the support of others who share this condition can be really helpful, even if it’s just a message board or an online community. Know that you’re not alone if breastfeeding fills you with sadness and dread. The more we talk about D-MER, the more normalized it becomes, and the more support nursing parents who experience it will receive.