Tania* is a new, breastfeeding mum. She shares this story:
“Within the first couple of seconds as my baby latched on, and coinciding with letdown, I felt this huge wave of anxiety and sadness engulf my whole being. The feeling lasted for only a few seconds. But during that time, I wanted to die, the feeling was that intense, and I wanted to hurt my baby very badly for making me feel this way.”
You might think Tania suffers from post-natal depression. But actually, she doesn’t. What Tania has is a condition known as D-MER (Dysphoric Milk Ejection Reflex), and one that is often confused with post-natal depression.
What is D-MER?
Image: Unsplash
According to D-MER.org, “Dysphoric Milk Ejection Reflex is a condition affecting lactating women that is characterised by an abrupt dysphoria that occur just before milk release and continuing not more than a few minutes.”
In other words, a mother suffering from this condition experiences acutely negative emotions (i.e. dysphoria) just before the letdown reflex occurs while breastfeeding.
The condition was only discovered a few years ago, with the term being coined by a group of US-based lactation experts who could not get to the bottom of why some breastfeeding women suffered from these drastic, unexplained mood swings while nursing.
There are three types of D-MER:
- Despondency
- Anxiety
- Agitation
What the mother experiences are dependent on where her dysphoria falls on her emotional spectrum. So, depending on this, the feelings she experiences could range from just homesickness to absolute rage.
There are also three intensities of this condition: mild, moderate and severe. The particular intensity experienced by a woman with D-MER depends on criteria such as how many letdowns per nursing session she has and how long the D-MER takes to correct itself.
It is not yet known why some mums experience D-MER while others do not. But expert belief at the moment is that it is related to how the hormone dopamine (read below for more on this) functions in certain women.
What happens during letdown?
When a milk release or letdown is triggered, levels of the hormone prolactin rise even before the milk starts flowing through the breasts.
A brain chemical called dopamine controls this release of prolactin and so, for the levels of prolactin to rise, the levels of dopamine need to dip briefly. And once the prolactin levels slowly rise, the dopamine levels re-stabilise – this happens to every single breastfeeding mother.
D-MER and dopamine
Experts believe the physiological (not psychological, like post-natal depression) condition of D-MER is related to a rapid and sudden decrease in dopamine just before breastmilk letdown, rather than a gradual dip. As soon as the dopamine levels correct themselves, the dysphoria disappears.
Dopamine is a hormone that releases ‘feel good’ chemicals such as endorphins around the brain. A rapid dip in this hormone leads to extreme feelings of sadness. And so, when experienced by a breastfeeding mother, this gives rise to D-MER.
However, research is still ongoing to find out the specific mechanisms involved with D-MER.
What does it feel like?
The Australian Breastfeeding Association describes the various words that women with D-MER use to talk about what they feel when the condition sets in:
- Hollow feelings in the stomach
- Anxiety
- Sadness
- Dread
- Introspectiveness
- Nervousness
- Anxiousness
- Emotional upset
- Angst
- Irritability
- Hopelessness
- Something in the pit of the stomach.
D-MER management
According to information from D-MER.org, the management of this condition differs according to the severity of the woman’s experience.
Mild D-MER
Mums with mild D-MER often find it much easier to manage the symptoms once they know exactly what they are dealing with. In other words, education about the condition helps such mums a lot.
Moderate D-MER
Education also helps these mums manage their symptoms better. If this doesn’t work, then such mums are encouraged to track their D-MER so they get a better understanding of what triggers the condition (e.g. stress, lack of sleep, caffeine) and what helps ease the feeling (e.g. more rest, drinking more water, exercise).
Severe D-MER
Women who experience severe and extreme feelings related to D-MER should seek medical advice without delay. Often, treatment involves prescription drugs that increase dopamine levels. However, certain natural remedies, such as eating one’s own placenta (via placenta encapsulation), taking vitamin B complex, or Rhodiola (a herb, also known as roseroot/ golden root) supplements may also help.
As always, medical advice must be sought before commencing any medication, whether prescription-based or natural.
More important facts about D-MER
Keeping baby up right helps. | Image source: iStock
- D-MER is not a dislike of breastfeeding. In fact, women with the condition generally say they enjoy breastfeeding except for the few seconds/ minutes of dysphoria.
- Mums with the condition experience D-MER related feelings just before letdown. It lasts for a few seconds to a couple of minutes.
- Depending on the intensity of the D-MER, a mother can experience negative feelings during just the first letdown in a feeding session, or in all subsequent letdowns.
- D-MER is not related to nipple contact or dislike of the sensation of nipple tugging.
Mums, if you are experiencing any of the feelings associated with D-MER as described in this article, it’s important that you speak to a doctor without delay.
References: D-MER.org, Kellymom.com
*Not her real name.
We hope you found this article informative and useful. Do share it widely with your friends who might be breastfeeding or pregnant.
