Sadness or anxiety before letdown: What you need to know about Dysphoric Milk Ejection Reflex (D-MER)
A sickening feeling develops in the pit of your stomach as your baby begins to nurse.
It's a feeling of anxiety, sadness, or anger that disappears as suddenly as it comes, yet it is so overwhelmingly uncomfortable that despite you loving it, you wonder if breastfeeding is worth it.
Occasionally the feelings of worry and guilt erupt spontaneously outside of nursing. Sometimes it happens when you're taking a warm, relaxing shower or when you hear your baby cry.
If the scenario above sounds familiar, it's possible that what you're experiencing is Dysphoric Milk Ejection Reflex (D-Mer).
I've written on the topic briefly before in a post titled Breastfeeding Taboo: Sexual arousal, orgasm and negative feelings, but I felt it necessary to have a more in-depth conversation on the subject. I also wanted to provide information and support resources so that you not only have a better understanding of what you're going through, but so you can also get the support and encouragement you need.
A quick note: this post contains affiliate links. Should you decide to purchase any of the products through the links I've provided in this post, I would make a small commission at no extra cost to you.
What is D-Mer
Though you may be able to identify the feelings you experience, it's possible this is the first time you’re hearing a name for what you're going through.
Dysphoric Milk Eject Reflex is the term to describe a wave of negative emotion immediately prior to your letdown. There's a quite of bit of variability among parents, with some only experiencing a mild "pang" of emotion and others having intense and severe waves of emotions which may even include suicidal ideation and thoughts of self-harm.
The emotional response to the milk ejection reflex (letdown) is the critical factor in D-Mer and separates it from other issues such as the baby blues or postpartum depression.
And unlike postpartum depression, D-Mer is a physiological response rather than a psychological one.
D-Mer typically presents within the first couple weeks after their baby is born and, in many cases, subsides by the time their baby reaches three months of age. For others, it will be something that requires constant management despite it improving over time, until their baby weans completely.
What does D-Mer feel like
Dysphoric Milk Ejection Reflex will feel differently to different people. There are generally three categories the range of emotions fall under: depression, anxiety, and anger/agitation.
Some common ways D-Mer is described include:
a hollow feeling in the stomach
anxiety
sadness
dread
introspectiveness
nervousness
anxiousness,
emotional upset
angst
irritability
hopelessness
general negative emotions
These feelings tend to last between 30 seconds and 2 minutes and may reoccur with every letdown or just the initial one.
Additionally many parents report that they get an aversion to food during this wave of emotion. It's not so much nausea as it feels as though they never want to/deserve to eat again.
This feeling of disinterest or aversion can apply to more than just food. A large number of parents state they feel that whatever they are thinking about at the time of letdown is unappealing, including their favorite activities.
What causes it
D-Mer is believed to be a dopamine-mediated response, meaning a change in dopamine level brings on the attack of negative feelings.
Though we often focus on the breastfeeding aspect of lactation, it's the interplay of hormones that makes sustained lactation possible.
For a letdown to occur, oxytocin levels must rise, and dopamine must drop to make way for prolactin, which is the hormone that signals milk production.
The drop in dopamine levels is suspected to be the cause of the D-Mer. The decrease may cause a temporary deprivation of dopamine to the brain resulting in the emotional response.
Those who experience D-Mer may have dysphoria in other situations as well, which may predispose them to this condition.
They may have or previously had similar negative feelings with other medical conditions such as restless leg syndrome or premenstrual dysphoric disorder. Additionally, some people may have dysphoria as an emotional reaction to nipple play during intimacy, before hot flashes during menopause, or a dysphoric feeling in their stomach before experiencing a seizure or after orgasms.
In all of the situations mentioned above, a decrease in dopamine levels could explain the negative feelings that are associated with those events.
D-Mer is NOT caused by a history of abuse, PTSD, a mental disorder or from a traumatic birthing experience.
How to lessen the symptoms
There is yet to be a "one size fit's all" remedy for D-Mer but here are some things parents report as helping.
Drink: Chug ice cold water before and during letdown
Distraction: Try to get lost in a mindless show on Netflix or do a distraction activity such as focusing on song lyrics as you listen
Deep Breathing: Doing deep breathing or meditation exercises can help manage the wave
Drain: Keep your breasts as empty as possible. The fuller the breasts are the more likely multiple letdown or spontaneous letdowns will be.
Dialogue: Keeping lines of communications open with your partner or support people is especially important. Many families have found ways to manage D-Mer by creating plans of action after extensive dialogue with their partners. Here’s a letter you can send to your partner that may explain your situation if you’re having a hard time finding the right words.
Drugs: Medications can be helpful for lessening the intensity of D-Mer. Zoloft and Wellbutrin are the two most commonly mentioned prescriptions drugs, but parents report B-vitamin supplements,** Rhodiola ** and L-Dopa ** and other supplements ** as having a positive effect.
Though there's little data to support its safety, many parents swear by CBD oil helping their D-Mer as well.
Should you wean?
Generally speaking, weaning is not considered necessary.
In many cases, parents can manage the waves of emotions until they start to subside around three months; however, this tends to be more likely for those who experience depression or anxiety type D-Mer.
From my time chatting with those who are affected by D-Mer, it does seem that there is an increased rate of weaning before a year compared to those who aren't affected.
It makes sense.
Outside of how severe, intense or overwhelming it can be, one of the biggest considerations for weaning I see pertains to how well parents feel they can bond with their babies while experiencing D-Mer. Many parents report weaning being the 'thing' that helped them to feel normal again and able to bond on a deeper level.
Other parents report that breastfeeding, despite the waves, is one of the best things they can do to feel bonded to their babies.
Parents have to decide based on their specific situation if weaning is the best option for them. Before you make your decision, I would encourage you to read the following post:
I feel it's important to note that for many people, D-Mer persists for some time after weaning. There seems to be some correlation of increased D-Mer attacks with a decrease in milk supply in some parents.
In any case, the tincture of time seems to be the most effective remedy for D-Mer regardless of the decision to wean or not.
You’re not alone
Though it may feel like it, you're not the only one who is going through this and you don’t have to do it alone.
I see it often, parents struggling for quite some time before stumbling upon the answer because they don't know there's a term to describe what is happening. And prior to 2008, there was a universal description for what some parents were experiencing, so I can’t imagine how much more isolating it must have felt.
If you have D-Mer but haven't yet joined a support group, please do. This Facebook group, which has over 2,000 members, is a fantastic resource .
And if you want more information on D-Mer than what I've provided in this blog post, I suggest you check out the official Dysphoric Milk Ejection site and/or read Before The Letdown: Dysphoric Milk Ejection Reflex and the Breastfeeding Mother. **
If you have D-Mer and want to share your experience below, please don’t hesitate to post it. Reading your comments may be helpful for those who are still trying to figure out if D-Mer is what they are experiencing.
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