Dysphoric Milk Ejection Reflex (D-MER): Why you're so SAD

Hey Friend

Have you ever heard of Dysphoric Milk Ejection Reflex (D-MER)? I hadn't. I recently came across it by accident while researching something completely different. I've never seen D-MER talked about, and I think if you're breastfeeding or thinking about it, you should know what it is. You might be in the 5-8% of women who will be inflicted by it. Let's dive in.

What is it?

D-MER is an abrupt emotional "drop" that occurs in some women just before milk release. It last for a few minutes, then disappears like nothing happened. But reappears the next time there's a milk let down.

What kind of emotional drop:

Feelings of overwhelm, feelings of low self-worth, guilt, hopelessness, shame, and a desire to hide from the world. The emotions are directed toward oneself and not toward baby.  Some afflicted woman also claim to lose the ability to concentrate during each episode. 
 
What causes this in 5-8% of breastfeeding people?

Since D-MER was only recently recognized (2011),  Early research suggests that an abrupt drop in dopamine may occur when milk release is triggered, resulting in a real or relative brief dopamine deficit for affected women. 

What is dopamine?

  Dopamine is a chemical released in the brain that makes you feel good. Having the right amount of dopamine is important both for your body and your brain. Dopamine is responsible for allowing you to feel pleasure, satisfaction and motivation. When you feel good that you have achieved something, it’s because you have a surge of dopamine in the brain. Dopamine also has a role to play in controlling memory, mood, sleep, learning, concentration and body movements.

So far D-MER is not related to postpartum depression (PPD) and postpartum anxiety (PPA).  While serotonin is the most popular neurotransmitter (chemical messenger) targeted by depression and anxiety medications, dopamine levels are also increasingly targeted in individuals with anxiety and depression as a "booster" to the serotonin meds. Since this is all new research and practice, I won't be surprised if in the future we discover dopamine levels are responsible for some PPD and PPA. 

If you think you may be suffering from D-Mer's, please talk to your Doctor, postpartum Doula or midwife.

Further Reading

You can learn more about D-MER by reading this interview

Dysphoric milk ejection reflex: A case report by Alia M Heise¹ and  Diane Wiessinger²

I'll update this section as more research becomes available.