WHAT IS DYSPHORIC MILK EJECTION REFLEX (D-MER)?
Breastfeeding is often portrayed as a serene bonding experience between mother and baby, but for some, it can be accompanied by unexpected feelings of sadness or doom. If you've ever found yourself experiencing negative emotions during breastfeeding, you're not alone. In fact, you may be experiencing a phenomenon known as Dysphoric Milk Ejection Reflex (D-MER).
What is D-MER?
D-MER is a distinct entity of its own - it is not the same as postpartum depression or other postpartum mood disorders. D-MER is an abrupt dysphoria that occurs when hormonal changes coincide with the letdown of milk, leading to feelings of sadness, nausea, or unease. Some simply experience a negative feeling that is hard to put into words. These emotions typically arise just before or during a letdown, sometimes for under a minute during the body's oxytocin surge (most likely due to a resultant drop in dopamine levels). For some, D-MER symptoms may persist throughout a feeding or may linger afterward.
D-MER is a disconcerting experience that can leave breastfeeding mothers feeling confused and distressed and can make them dread each time they feed their baby. We do not fully understand how and why D-MER occurs for some women and not others, but it is thankfully becoming more recognized by health care providers, though it is not yet listed as an "official" diagnosis in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Is There Treatment for D-MER?
The first step in coping with D-MER is understanding that it's a legitimate medical issue, not a reflection of your mental health. Many mothers express relief upon learning that what they're experiencing has a name and a possible explanation. It's important to reassure yourself that you're not alone and that there are ways to manage these symptoms.
Interestingly, some find that D-MER occurs only with pumping, not with direct nursing. Some find it's the other way around. Finding patterns can help you adjust how you provide your baby with your human milk to lessen the effects of D-MER.
For some, DMER resolves on its own within three to four months of starting lactation. However, if symptoms persist or significantly impact your breastfeeding experience, there are strategies and interventions that can help:
Self-care: Self-care plays a crucial role in managing D-MER symptoms. Prioritize activities that promote overall well-being, such as staying hydrated, exercising, and getting adequate sleep. The healthier we are, the better we will be able to handle difficult personal experiences.
Distraction: Engaging in enjoyable distractions, like watching a funny TV show or playing a game on your phone, during breastfeeding sessions can also help mitigate negative emotions.
Counseling: Getting help from a perinatal mental health professional can be hugely beneficial for D-MER. Cognitive Behavioral Therapy (CBT) in particular can help us learn how to move from negative thinking to a more productive, positive line of thought. Therapy can also help us simply deal with the stress of having a condition such as D-MER and can help us feel heard and supported through the experience.
Medications: In more severe cases, medication may be necessary to alleviate symptoms and make breastfeeding more manageable. Consulting a healthcare professional, such as an International Board Certified Lactation Consultant (IBCLC), your primary care provider, or a Breastfeeding and Lactation Medicine Physician can guide appropriate treatment options.
Getting Help is Essential
It is important to note that while D-MER is a potential explanation for negative emotions during breastfeeding, it's not the only possible cause. Pain during breastfeeding, personal mental health factors, or external stressors may also contribute to feelings of distress. Regardless of the underlying cause, seeking support is essential.
If you suspect D-MER or are struggling with negative emotions during breastfeeding, don't hesitate to reach out for help. Whether it's through discussing your concerns with a healthcare provider, seeking support from a therapist, or connecting with other breastfeeding mothers, remember that support is always available. Postpartum Support International is a fantastic resource to help you with immediate assistance through their Warm Line and also with help finding local resources.
By understanding D-MER and implementing coping strategies, you can navigate your breastfeeding journey and its challenges with greater confidence and ease. Remember, support is always within reach.