Mom bottle-feeding her baby.

What to Know About Dysphoric Milk Ejection Reflex (D-MER)

Making the decision to breastfeed your baby is an important one, but it’s not always easy. Millions of women struggle to establish breastfeeding, have issues with latching, and face several challenges throughout the nursing journey. This is completely normal. However, as sleepless nights accumulate and breastfeeding continues to be a struggle, some new mothers begin to experience more negative feelings than positive ones. If you notice that you feel an overwhelming sense of negative or depressing feelings right before your milk lets down during nursing, you may be experiencing something called dysphoric milk ejection reflex, or D-MER. Here, we’ll go over everything you need to know about D-MER to help you better understand this condition and how to overcome it.


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

Breastfeeding is one of the best options for providing your newborn with the vitamins and minerals necessary for development. It also gives new mothers an opportunity to bond with their newborns, which can help strengthen future emotional and mental development. While the act of nursing tends to be associated with positive feelings and excitement, some women may notice that they feel anxious or even depressed. When this happens right before their milk lets down, it’s known as dysphoric milk ejection reflex (D-MER).

D-MER is a condition that’s associated with a flood of dysphoria (negative feelings or emotions) that is directly related to milk letdown. The feelings tend to come immediately before letdown and may continue for a few minutes after. The dysphoria is fleeting, but it can still be extremely difficult to deal with.

Experts believe that D-MER is a physiological reaction, meaning that it’s a real, medical condition that’s caused by internal triggers. It is not considered psychological.

How D-MER is Different from Postpartum Depression

Unfortunately, it’s not uncommon for new mothers to experience some degree of sadness after delivery. Postpartum depression can affect up to 20% of new mothers and up to 80% of new moms experience the baby blues at some point after delivery. While these feelings aren’t uncommon, they’re different from D-MER. Dysphoric milk ejection reflex only occurs during letdown and is much more fleeting. In fact, D-MER may only last a few minutes, making it feel a bit surreal.

However, it is possible to have both dysphoric milk ejection reflex and postpartum depression or the baby blues. If you’re experiencing any feelings of sadness, rage, apathy, irritability, or despair, don’t hesitate to reach out to your doctor. There are treatment options to help you cope with these feelings and the sooner you get professional help and support, the sooner you’ll feel better.


Symptoms of D-MER

As mentioned, dysphoric milk ejection reflex often results in feelings of sadness, depression, irritability, anger, or even anxiety. Every woman may experience D-MER differently, but in general it’s associated with negative feelings during your letdown or shortly beforehand. Some women may experience more severe cases of D-MER, while others may only have mild feelings of despair. Some of the other symptoms commonly associated with dysphoric milk ejection reflex include:

  • A feeling of hopelessness
  • Unexplained panic or paranoia
  • Feelings of dread or impending doom
  • Anger
  • Irritability
  • A feeling similar to homesickness
  • Self-loathing
  • Suicidal thoughts


Although the symptoms of D-MER can vary, they tend to dissipate after around 10 minutes or less. They only appear during breastfeeding, usually around your letdown. If you’re having any suicidal thoughts or feelings like you can’t cope, see your healthcare professional as soon as possiblestart your order

What Causes Dysphoric Milk Ejection Reflex?

The exact cause of dysphoric milk ejection reflex is unknown, but it is related to two hormones—oxytocin and prolactin. Both of these are released during breastfeeding. Oxytocin is what aids in the ejection of milk, while prolactin helps your body with the production.

Both hormones are triggered by the act of breastfeeding. Oxytocin is released almost as soon as your baby latches on to your breast, while prolactin is gradually released over the course of nursing. While both of these hormones are supposed to help with breastfeeding, they also impact the neurotransmitter and hormone that’s responsible for a positive mood—dopamine. Experts believe that D-MER is therefore caused by a more sudden response to oxytocin, which both inhibit the release of dopamine. This could also explain why feelings associated with D-MER end as your prolactin levels raise and balance the oxytocin.

Women who experience D-MER may notice that symptoms get less severe as their baby gets older, especially after the three-month mark. This could be due to a declining breast milk supply, but the exact explanation is still unknown.


D-MER Diagnostics and Treatment

If you’re experiencing any negative feelings or emotions associated with breastfeeding, it’s important to see your healthcare provider as soon as possible. Unfortunately, there’s no exact diagnostic test for dysphoric milk ejection reflex. Instead, your doctor will ask you some questions and explore the emotions you’re feeling. If they tend to dissipate as soon as nursing is over, it’s likely that you have D-MER. While many women want to continue nursing, the negative feelings may continue to happen. To help you manage D-MER while nursing, consider some of the following tips:

Engage in Skin-to-Skin Contact

Skin-to-skin contact with your baby can help increase feelings of happiness and love. It’s been shown to reduce both you and your baby’s heart rates and cortisol levels, which can help you create a stronger boob-brain connection and ward off negative feelings. Some women notice that engaging in skin-to-skin contact is all it takes to alleviate any negative emotions felt during breastfeeding. It can also help you create positive memories and increase the bond between you and your baby

Get Extra Support

Don’t be afraid to reach out to your partner, friends, family, or even a healthcare professional. If you’re having any negative emotions or thoughts, it’s important to get extra support to help you through them. Since D-MER is often associated with the fight or flight response, surrounding yourself with loved ones can help counteract any stressful or anxious feelings. There are also several great support groups you can join online.

Be Proactive About Your Mental Health

Becoming a mom can easily cause you to lose sight of yourself. However, it’s important to give yourself time to recover and adapt. You are still your own person, so don’t put your mental health on the backburner. If you’re struggling, consider seeing a professional. You should also ask for help with the baby, so you have some time to do a few things for yourself. Even if it’s just an hour a week to relax in the bathtub, that time makes a difference.

Practice Mindfulness

Finally, try to practice mindfulness when you’re nursing. If you start to feel any negative emotions or feelings, take a few deep breaths, repeat your favorite mantra, or try to visualize something that makes you happy. By focusing on being in the moment, you can remind yourself that you’re nourishing your baby and try to overcome your feelings. Mindfulness may also help you better understand and process any negative emotions felt during nursing, which can lead to lower stress levels.

While some women are able to manage the negative feelings associated with D-MER, women with more severe or intense feelings may not be able to. If you’re experiencing feelings that seem to be unmanageable, talk to your doctor. The best option may be to wean your baby off breast milk. You can work with a lactation consultant and your baby’s pediatrician to find the best alternative for your situation, but don’t be too hard on yourself. D-MER is a serious condition that can be extremely difficult to manage, especially if it’s combined with another postpartum mood disorder.

If you or a loved one is experiencing any signs or symptoms of D-MER, it’s important to seek treatment from a healthcare professional. There are additional resources available to help you reduce the intensity of symptoms. To give your partner the opportunity to help with supplemental feedings, Byram Healthcare offers a wide selection of insurance covered breast pumps to new and expecting moms. This allows you to build a freezer stash so you can rest when you need to and still give your baby all of the vitamins and minerals they need for development. To learn more, browse our breast pump selection and get started with our easy, three-step ordering process today.