A resource to inspire, inform and empower parents.

Dysphoric Milk Ejection Reflex (D-MER)

By guest blogger Nichole

There was never a doubt in my mind that I would breastfeed.  My mother nursed all of her children; to me, it always seemed normal, blasé, even.  (I have a sister who is six years younger than me, and I vividly remember trying to catch milk like raindrops when I would take showers with my mother and she would let down.)  Mom had described breastfeeding as one of the most, if not the most, rewarding experiences of her life.  It came naturally to her (and apparently to her children as well).  So when I became pregnant, breastfeeding didn’t even seem like a choice; it was just what I would do.

mother with d-mer

I count myself extremely lucky that, much like my mother, nursing came naturally to me and my son.  Hank was born on September 22, 2013, and he latched like a champ from the very beginning.  Hank was (and still is) an “eager eater” according to our lactation consultant (nursing for 45 minutes on each side the night he was born), and I have “amazing nipples” (one of the strangest compliments I have ever received from a heterosexual woman).  Even our “problems” weren’t problems.  Hank has reflux, but is a “happy refluxer,” gaining weight at a steady pace and smiling through his constant spit-up.  I had, believe it or not, too much milk and had to block feed for a period of time.

But despite my eagerness to speak with a lactation consultant about the “problems” that weren’t, I did not speak to anyone about the emotional problems I was having every time I nursed.  Eight or more times a day, for four months, when I nursed, I experienced panic attacks.  And until three weeks ago, I hadn’t told anyone.

I can’t entirely articulate the reason for my silence.  Having suffered from anxiety and depression for years and having spent a considerable amount of time actively engaged in cognitive behavioral therapy, I knew how to identify and deal with panic attacks.  Perhaps because I possessed these tools, it never seemed like I needed to tell anyone.  Of course, even with this knowledge, a panic attack is tiring and taxing, often requiring some mental gymnastics to quiet the feelings and thoughts accompanying it.

If I really, truly consider the reason for not speaking-up, I think it was because the panic attacks made me feel so different, so disconnected from the feelings I thought I would have while breastfeeding.  I expected euphoria, connection.  But I was feeling anxiety, disconnection.  And there was no reason for me to be feeling these feelings.  I loved my baby; breastfeeding was so easy.  I was being so irrational.

But that’s the thing about anxiety and depression.  They aren’t rational.  But “rationality” makes feelings neither less real nor less painful.

Just like I did not know my reasons for silence, I do not know why I finally decided to break that silence.  Three weeks ago, my mother was visiting.  I was quizzing her about extended breastfeeding, and I mentioned in passing that I might not breastfeed as long as I would like because of the feelings of anxiety I had been having.  My husband, well-versed in my struggles with anxiety and depression immediately encouraged me to speak with my OB, lactation consultant, and/or therapist.  Upon doing so, and conducting some research, I discovered I have Dysphoric Milk-Ejection Reflex (“D-MER”).  In sum, when prolactin is released during breastfeeding, dopamine, a prolactin inhibitor, drops.  Some women either feel this dopamine drop more acutely than others or have a dopamine drop that is more marked than what is expected.  This dopamine change can cause feelings of “dysphoria,” typically anxiety or depression.  It can range from mild to severe.  It can be treated, and, for many women, it goes away after breastfeeding for some time.

mother with d-mer

Thankfully, five months into breastfeeding my son, the D-MER seems to be subsiding.  But as I write my story of D-MER, I wish I had not remained silent.  I wish I had said something sooner.  For me, motherhood has brought the most intense feelings of both connection and disconnection.  Never before have I felt so connected to a human being, my son, but I have also never felt so disconnected from my social circle.  Every day, I feel that I have never been more connected or disconnected to my husband.  I’ve never been so in tune with what I need and so unable to actually achieve those needs.  The moments of connection are enthralling, euphoric.  The moments (or even days or weeks) of disconnection can be devastating.  I let D-MER be another point of disconnection when I could have spoken-up about it and used it connect me to a community of mothers who also experience it.

My hope in writing my story is that mothers that experience D-MER (and even those that don’t) will talk to someone long before I did.  That we will reach-out and overcome the feelings that D-MER causes by seeking help and connection.  For more information, I encourage you to begin here:  http://d-mer.org/Home_Page.html.

All my love to you badass mommas,

Nichole

Comments

  1. Fantastic article! I, too, have had D-MER with all five of my babies, although I didn’t know what it was until 3 years ago with baby #3. It does make breastfeeding difficult, but I have never let it beat me. I have found that mentally preparing myself before every feed helps to get through those 30-60 seconds of panic and depression. Just reminding myself that’s it’s not a “real” feeling, so to speak, but rather just a reason to what my body is doing, helps maintain my mental health during our breastfeeding relationship.

  2. Sorry, reason should have been reaction.

  3. thank you for your words. I myself am struggling with many things with baby #3. I always thought “other” women suffered from these sort of things.
    my 1st two pregnancies and breast feeding experiences were effortless.
    thank you for having the courage to speak about your experience, very helpful to others.

  4. Wow, it never occurred to me the panic & crazy spiraling thoughts I would have nursing were something other people experienced or even had a name. This would happen to me all the time when nursing and I just chalked it up to having too much quiet time during what was already a hormonally charged post partum period. I noticed this was even worse at night when everything was completely silent. Every so often I thought I might scream if the feeding took much longer. I started finding my own ways to cope such as writing notes or emails to myself on my cell phone during late night feedings. or becoming more comfortable nursing around others so I had a distraction. Eventually things got better around 6 months and I never gave it too much more thought. Thanks so much for sharing this! I’m expecting my second and while I love nursing for some reasons, I definitely am already not looking forward to night feedings.

  5. Thank you so much for this article. It came at the most perfect time for me and I applaud your bravery. I have a 4 month old who is exclusively breastfed and didn’t know what I was feeling until reading this. I feel as though we have the same story, even my little guy has been named a “happy spitter”. I think my anxiety has gotten better and now I’m dealing with the depression that comes along with realizing I haven’t gotten back to the pre-baby weight as fast as I hoped. But in the beginning my anxiety surrounding breastfeeding would start right after I was done and anticipating the next feeding. It’s refreshing to know this is something that happens and that I’m not just loosing it. Thank you again.

  6. Thank you very much for sharing your story as I read I felt something click. When I started nursing I noticed my anxiety levels shoot up also I never said anything to anyone. It was no where near as bad as yours and I don’t know why I didn’t say anything either. Maybe I thought it was normal because I’ve never been around a breast feeding momma before. Luckily mine was not bad and went away after a few months. I am happy to say my son is almost 7 months old and we are still ebf :). It took us a month and a half to get that way though due to his being born 7 weeks early and having to stay in the nicu for 20 days. Nursing was very energy depleting for him being 4 lbs 7 oz at birth so we waited to get him home before starting to nurse I pumped every 2 hours for him while he was in the hospital though so all he had was my milk and 2 high cal formula bottles a day to help him gain weight fast once home I stopped that and here we are a happy ebf mommy and baby

  7. I so did not know there was a name to what I was feeling! Wow, I really feel in lightened. I just thought it was me. After my first and experiencing baby blues I just thought it was the blues creeping under the surface and I was fairly certain it was hormonal d/t the wave of depression that came with her latching! Thank you for speaking out! I know I’m not crazy now!

  8. Amity Jones says:

    Wow! Im in mid third trimester w/daughter #3 & had never heard of anything like this. THANK U! I also experienced what I believe now to be something like dmer with my last baby & felt like a monster for it. Thank u soo much for not remaining silent. Best wishes to u & ur family.

  9. How interesting! I think I had this with my second child and I never knew what it was until reading this. Mine was mild – just a sadness, for lack of a better word, for a minute or so after letdown. It did eventually go away but it was definitely frustrating while it lasted. Glad to know it was only hormones.

  10. Thank you for writing this article. Your story could be mine exactly if you throw in a nipple shield, over active letdown and a not do quiet case of relux. My dmer manifests as a sudden feeling if hopelessness… Like the bottom just dropped out of my life. I didn’t tell anyone at first either. Having also struggled with anxiety and depression my whole life I didn’t want anyone to think I had post partum depression. I was not depressed and I didn’t want people worrying unnecessarily about my mental state but the fact remained that I was struggling with this in silence. I found out I had it accidentally by reading an article on kellymom and putting two and two together. Myson is 4 months old now and it has lessened. Actually until I read your article I hadn’t thought about it much lately. I hoping that’s a sign it’s pretty much gone. Thanks again.

  11. Excellent article!!! Thank you for sharing Nichole! Please please please keep telling your story!! Other badasses need to know they are not alone!! You rock!

  12. I am so excited to see the term D-MER make it’s way to this website. I must say though, that this article, while a very candid recount of the authors experience, does not do justice to what some women go through in regards to this debilitating hormonal imbalance. I had oversupply and with that came spontaneous let-downs. My D-MER felt like anxiety at it’s best! More often it was utter disgust, aversion to food or drink, sheer irritation, absolutely convincing panic of impending doom and complete inability to cognitively process the simplest of conversations or transactions. Between feedings and spontaneous let-downs, at my height of nursing, I would experience these dysphoric episodes up to 30 times a day. These moments would come while at the check out buying groceries, disciplining my toddler and conversing with my husband. It was a debilitating interruption to my life and mental stability. Couple that with sleep deprivation and the regular day to day challenges that new mothers face and it’s amazing I survived. Like the author, I had a solid background in cognitive behavioral therapy to help me get through the episodes. I truly do not know what would have happened to me if I was someone who did not happen to have a degree in psychology and insurance that allowed me to attend therapy in the past for mild, generalized anxiety. Even more so, with dairy intolerant babies I was under immense pressure to breastfeed because the proper formula would have been more money than we could have afforded at the time. I made it to 7 months when their systems finally allowed them to manage regular formula. It was a dark, lonely, life changing 7 months both times. What I feel is most imperative to point out is that D-MER is NOT TREATABLE. There is no known medication, herbal supplement or diet that has been proven to have any effect on D-MER symptoms. For many women, myself included, it will not fade away either. I weaned my second child 18 months ago and still make a small amount of milk and still have D-MER episodes from time to time. I wanted to comment on my experience because I want to impress upon how important this issue is to women’s health in hopes that the medical community will take note and be able to help mothers cope.

    • Oh Mel, thanks for clarifying and emphasising how horrible this condition is. I experience it much like you, food aversion, disgust, deep shame, etc, and I’m going through it right now trying to feed my son till he’s 6months old (at least) and counting the weeks… It just gets heavier and heavier trying to shoulder this so many times a day. 2 weeks to go until he’s 6 months but will I allows myself to finally quit then? I feel selfish not feeding my son breastmilk but oh does this suck 🙁

    • I have found that Ginseng, Rhodiola (Golden Root), and Fish Oil capsules, taken daily with a multivitamin, help somewhat. ….I suppose it’s better than nothing. I am still dealing with the EXTREME DOWNS, but feel 10 times worse throughout the day, if I do not take the herbal supplements.

    • Yes, Mel, I am in the exact same boat. I have let downs frequently throughout the day due to oversupply. I can always tell when my milk is going to let down because I suddenly my feel so sad, gross, anxious, and sick. I have to tell my husband to talk to me in a few minutes while it lets down because I can’t make any rational decisions or even focus while it happens. It’s so strange and I had it all 12 months of nursing my son, and am on month two of nursing my daughter. It’s a 24/7 struggle.

  13. Thank you for posting this. I never knew the official name for it but I experience it as well. It was much worse in the beginning and it would last only a little while during the first let down. Fortunately I went online early on and saw that others had similar experiences and I wasn’t as concerned. Now my son is a year old and we are still breastfeeding. It vary rarely happens now. Thank you again for writing this.

  14. I had a similar experience with my first, and because he feed every 1-2 hrs it felt like never ending waves of anxiety and depression. I was diagnosed with post partum depression and with medication improved somewhat. No one really believed me when I said it was connected with breast feeding and happened even when pumping. I continued to breast feed exclusively for 4 mths, but my relationship with my child improved drastically when I stopped. Thank you so much for this article. It really takes some of the shame out if my experience and gives me hope that with my next child I may be able to find ways to cope better and breast feed longer.

    • I actually enjoy bfing my 4mo son. It’s when I have to pump that the dmer goes into effect. I have severe panic attacks to crying to being mad or p-ed off at the world. I have been trying to not let it effect the rest of my day, but it’s really hard and seems to be getting worse. I don’t know if it has anything to do with the fact that I’m pumping at work and have guilty feelings of leaving my children at home (with family that watches them).

  15. Hi, I do not have D-MER, however I cared to look on the net if any treatment was available and I did find a single case article stating that one woman had decrease in symptoms taking Rhodiola rosea pills as the plant is a “monoamine oxidase inhibitor that prevents the breakdown of dopamine”. Hope that helps, all the best.

  16. Wow! I’ve never heard of D-MER and am so glad I read this.

  17. WOW! I have to say that reading this article was somewhat eerie, it was asif I had written it myself. I have never heard of this condition and apparently neither had my pcp, ob/gyn, or my endocrinologist. I am astounded right now that no one ever mentioned or tested me for this. My son is now three and he latched right on and nursed like a champ for 25 months. I had severe over supply in the beginning and vividly remember surprising the nurses when they gave me the pump in the hospital and I came out with 6 bottles full and asked, when do I stop? I thought 13 ounces was a bit much. The weeks that followed I would nurse and have a very quick let down and feel almost comatosed. I asked and asked but the drs all said it was normal. I WISH I would have heard about this earlier. Thank you for the information and thank you for always writing such wonderful stories. I can see I’m not the only one that had felt so good and so bad at the same time.

  18. Wow, that’s what I was exploring for, what a material!
    existing here at this webpage, thanks admin off
    tgis web page.

  19. I’m so happy to find that there is actually a term for this condition and hopefully it can be better understood and talked about. I first noticed it when I had my first daughter, but then I only breastfeed for 10 days. I never told anyone or researched it but I remember feeling empty, hollow and sad when I feed her and also when I was pumping. Now I’m breastfeeding daughter number 2 and I have the same feelings again. I’ve never struggled with depression or some kind of mental illness before so this feels really strange to me. I haven’t told anyone because I feel like they will misunderstand and think it is baby blues or a mild post natal depression. I’m certain it’s not and it is D MER but unless you have experienced it yourself I think it’s hard to understand, especially since it seems so be so unknown. I want to continue breastfeeding or at least pump but to honest I’m not sure if it’s worth me feeling like this for such a large part of the day. One part of me loves to breastfeed my daughter and and the other part dreads it. I hope it can be better understood and known, because the only thing that has helped me is understanding it’s a physiological effect due to drop of dopamine and not just me going crazy.

  20. Apparently, I’m one of the unlucky few who feel intense anger that lasts for at least a few minutes. It was so frightening and confusing! And since I can’t feel my let downs, it took me a whe to realize what was going on. My D-MER is not mild or moderate. I wish I didn’t feel so alone in this. Doesn’t anyone else feel severe agitation and anger?

    • Hi Raine,
      You posted back in March and I just now found this site and posted my story. My panic attacks when nursing were severe, yes. The fact that you felt it as anger is understandable – the way I see it is that it’s just a crazy intense shot of hormones and it can differ so much from person to person. Another woman I know felt it as extreme depression. I wonder how you are doing now?

  21. Thank you so much for writing this. I was diagnosed for postpartum depression/anxiety at around 5 months, although symptoms began at around three months. I struggled with a colicky baby, fast ejection, and oversupply. I had panic attacks and also severe insomnia. I struggled with the postpartum depression diagnosis, not because I rejected a medical diagnosis/treatment but because I just had a feeling that wasn’t quite accurate. I was given an anti-anxiety medication to use at night because the sleep deprivation was so out of control with insomnia on top of feeding through the night. I would feel severe anxiety when feeding but I also never put it together… I just thought it was spiking at those times since I was “pinned” under the baby.

    I was also given Zoloft and I am just now weaning from that. I’m not exactly sure if it helped me, but I was able to get off the sleep aid after about 5 months – much longer than I would have liked.

    I also really exacerbated my problem without knowing it… Around the three month mark, before having it as a clear problem, my neighbor adopted a baby. Since I had not been able to get my oversupply under control, I thought it was serendipitous and I decided to pump quite aggressively in order to donate milk to the new adopted baby who would exclusively be on formula otherwise. I continued this, donating 10-12 ounces of milk per day. After about a month of this I began to get the insomnia, which led to more anxiety and less ability to cope, leading to more insomnia, and the panic attacks just getting worse and worse. My husband was freaked out and unable to be supportive since he thought I was “driving myself crazy” and that I should be able to simply not do that. Jeez. My family and friends had all been so supportive and impressed regarding the donating of the milk. My lactation consultant was also supportive and choked up over it, as were my doula and midwife. No one thought any harm could come of it.

    By the time my sister finally asked if perhaps I should stop donating since my body wasn’t begging given a chance to adjust to the needs of my baby, I was already deep in a hole. And I was so scared of panic attacks and scared of myself and my thoughts and my connection to the earth, to by body, and my baby, that it took on a life of it’s own and sort of perpetuated itself.

    As someone else commented, there is currently no treatment. But I feel that knowledge is a great treatment, and would have been for me! I found this page since I just met a man who told me his wife went through this around 10 years ago and never got a diagnosis but they figured it out, that she felt depressed during feedings. They got through it and on their second child, she chose to breastfeed but a simple solution was to always have the TV on or friends around and other fun distractions specifically during feedings. I never would have done this since I thought that it was supposed to be a sacred quiet time of bonding and putting the phone away, thinking about how much I love my baby. My lord, the pressure.

    Thanks so much, Nichole!

  22. lookie here

  23. Thank you for sharing your experience. I’m going through this once again with my 2nd child.
    I found out about this after 2 months of nursing my 1st child. By that time I was already exhausted and lonely when my name be of my friends understood what I felt. Most of the time they’d say they wondered how I went on breastfeeding and making myself go through these depressing episodes. I guess it explains why I stopped nursing my lovely baby after 4 months. I felt even more guilty as he had no problem whatsoever with my milk.
    This time I feel stronger. I was hoping it wouldn’t happen with #2 baby. But being able to identify this D-Mer phenomenon makes a lot of difference. It still spoils a bit those tender moments with baby but I’m not ashamed any more. As someone else said, I act as if it wasn’t real. I know that 5 seconds later it’s all gone.
    Thank you again for this article!!!

  24. kzlm.com

  25. Thank you for this. I just had my first baby; a beautiful girl, and have had TERRIBLE D-MER. I am 4-months in and exclusively breastfeeding and for the first time today at my baby’s 4-month visit I mentioned it in passing to her pediatrician who, unknown to me, also is a lactation consultant. She immediately was able to help suggest DMER as a diagnosis and is helping get me back on track emotionally and feel more stable. I am SO glad to hear that I am not on my own. I talked to my OB/GYN at her 6-week apt and also went last week for an apt trying to let them know I didn’t think things were right, but I was waved away and then given a medicine that interacted harshly with my baby. Very thankful for a new doctor.

  26. Leah M Peterson says:

    Wow. Way to speak right to my mommy heart. I felt the same way you did. Thank you so much for putting your feelings out there.

  27. Thank you for sharing!! I have this and I feel crazy. The 2 doctors I’ve spoke with about it have never heard of it which makes me feel even more insane. It’s hard to find support because it is rather uncommon. Thank you for speaking out❤️

  28. Hello fellow d-mer ladies! I did a quick google after experiencing this the first few times; I felt nothing but loveliness with my first child nursing, so I knew something wasn’t right. I do suffer from many different flavors of anxiety and initially thought it was just panic attacks until I realized it was only happening during letdown. I have determined that this only happens to me when my physical needs have not been met; if I have adequate water (100-150 ounces a day for me) and food (3000 cals a day, I do an hour a day on my arc trainer or more, must include protein and greens), plus rest, it does not happen. I therefore now believe that, at least for me, this is a warning system in place. I hope this helps someone.

Speak Your Mind

*