Dysphoric Milk Ejection Reflex: Causes, Symptoms, and How to Cope

Does breastfeeding bring up sudden, intense feelings of sadness for you? If so, you might be experiencing D-MER. Keep reading to learn about this phenomenon and what to do about it.

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For many new moms, breastfeeding is a happy bonding time to nurture and connect with their baby. However, for some mothers, breastfeeding comes with an unexpected wave of negative emotions, including depressed mood, irritability, or even a sensation of homesickness. These emotions can feel confusing, isolating, and even guilt-inducing. 

This experience is known as dysphoric milk ejection reflex (D-MER): a condition in which mothers feel sudden, intense negative feelings just before their milk lets down, or when their breast milk starts to flow.

“Dysphoric” comes from the term dysphoria. The word dysphoria describes a deep sense of unease or emotional discomfort, which perfectly captures what some mothers feel just before their milk lets down. Research is limited and estimates vary, but the latest research says that up to 14.2% of lactating mothers experience D-MER. Here’s what you need to know about the dysphoric milk ejection reflex, including symptoms, causes, how to cope with it, and more. 

What is dysphoric milk ejection reflex?

“Dysphoric milk ejection reflex (D-MER) is a physiological condition that affects some lactating individuals, characterized by a sudden wave of negative emotions — such as sadness, anxiety, dread, or irritability — that occurs just before or during milk letdown, or the milk ejection reflex,” says Meghan Jensen, LPC, MA, BS, a Charlie Health Primary Therapist.

Dysphoric milk ejection reflex symptoms

D-MER symptoms can feel intense and tough to cope with. These symptoms can have a profound effect on psychological well-being, says Brooke Cortez, MSW, MT-BC, NMT, a Charlie Health Creative Arts Therapist at Charlie Health. The symptoms occur at the time of milk letdown, before milk release.

According to Cortez, common dysphoric milk ejection reflex symptoms include negative feelings such as:

• Sadness
• Feeling hollow
• Homesickness
• Increased anxiety or nervousness
• Feeling of dread
• Agitation
• Increased tension 

Dysphoric milk ejection reflex irritability is also common, and you may feel angry or easily frustrated alongside your depressed mood. 

However, D-MER symptoms are short-lived. “These emotions typically last 30 seconds to two minutes and then quickly subside as milk flow continues,” Jensen says. Even though the symptoms are short-lived, the phenomenon can happen multiple times a day as you breastfeed your baby, and you might develop anxiety, reduced desire, or an aversion toward breastfeeding due to these symptoms. 

In severe cases, you might also experience suicidal thoughts, Jensen says. In this instance, contact the 988 Suicide & Crisis Lifeline for immediate 24/7 support. 

What are the causes of dysphoric milk ejection reflex?

The cause of D-MER is thought to be linked to hormonal fluctuations during milk ejection. Hormonal changes connected to breastfeeding can result in changes to dopamine, a neurotransmitter (brain chemical) linked to mood. When you’re breastfeeding and experiencing the milk ejection reflex, hormones undergo significant changes.

Jensen says the following fluctuations in hormones may be responsible:

• For milk to be released, levels of prolactin (the milk-producing hormone) must rise.
• Dopamine inhibits prolactin release. So, for prolactin levels to rise, dopamine levels must temporarily drop.
• The sudden, temporary drop in dopamine causes an abrupt and intense emotional reaction in people with D-MER.

The hormone oxytocin may play a role, too. “Oxytocin, the ‘bonding hormone,’ triggers the milk ejection reflex,” Jensen says. “While oxytocin typically promotes calm and bonding, its release may amplify emotional sensitivity, making the dopamine drop more noticeable.”

How long does the dysphoric milk ejection reflex last?

In many cases, D-MER symptoms should get less severe and resolve within three months of breastfeeding. In rare cases, D-MER may occur for the whole length of time that you breastfeed your baby. Everyone is different. 

What’s the difference between dysphoric milk ejection reflex and postpartum depression (PPD)?

“PPD is considered a psychological mood disorder, while D-MER is usually triggered by a physiological hormonal response,” Cortez says. “Additionally, emotional symptoms with D-MER are usually short in duration, lasting no longer than 30 minutes during the letdown portion of breastfeeding. In PPD, emotional symptoms can last for a majority of the day, or in some cases as long as two weeks.” 

However, she notes that shared emotional symptoms occur with both diagnoses, particularly depressive and agitation symptoms.

Some people have both dysphoric milk ejection reflex and postpartum depression, but the two conditions are distinct.  Additionally, D-MER could contribute to PPD. “The distress caused by D-MER, especially when misunderstood, can increase emotional strain, heightening the risk of developing or worsening PPD,” Jensen says. Another key difference is that D-MER is linked specifically to milk release, while PPD involves mood symptoms that are not limited to breastfeeding, Jensen adds. 

Other postpartum depression symptoms include:

• Ongoing feelings of sadness
• Feeling empty or hopeless
• Increased irritability
• Losing interest and pleasure in things you used to enjoy
• Changes to sleep and appetite
• Otherwise unexplained aches and pains (like headaches or muscle pain)
• Fatigue
• Thoughts of self-harm or harming the newborn
• Trouble bonding with your baby 

In instances of comorbid PPD and D-MER (especially in moderate to severe PPD cases), a healthcare provider might suggest treatment with an antidepressant medication, such as a selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI).  

Dysphoric milk ejection reflex treatment

There is no official single treatment for D-MER, but help is available for new parents coping with this phenomenon. 

1. Therapy

Therapy is always a good idea for any type of mental health-related struggle. It can help address your emotional responses and teach you coping strategies, Jensen says.

While therapy won’t stop the physiological process that results in these negative feelings, it can teach you how to better cope with them. 

2. Gradual weaning

Gradual weaning refers to tapering off breastfeeding and feeding your baby other food, such as formula, if they’re under 12 months old. Or, if they’re over 12 months, consider feeding them plain, pasteurized whole cow’s milk.

“If D-MER is severe and persistent, gradual weaning may be considered after consulting with a healthcare provider, especially if the emotional distress outweighs breastfeeding benefits,” Jensen says. 

3. Dysphoric milk ejection reflex natural treatment

Natural remedies, particularly herbal support, may play a role in treatment. “Certain supplements (such as Rhodiola rosea or tyrosine) have been explored anecdotally for dopamine regulation — but only under provider guidance,” Jensen says.

Only take these herbs if you’ve gotten clearance from your healthcare provider first, to ensure that a herbal remedy is safe for both you and your baby. 

How to cope with dysphoric milk ejection reflex

There are plenty of steps you can take to feel better while dealing with this phenomenon. Here are 8 tips for coping with D-MER.

1. Acknowledge and validate your feelings 

It’s crucial to acknowledge your feelings with compassion and know this isn’t your fault. You might feel guilty or confused, thinking there might be something “wrong” with you since you don’t feel joy while you breastfeed, Jensen says. However, this is a physiological response that’s out of your control, and it doesn’t mean there’s something wrong with you as a mother.

“Understanding that D-MER is a biological, not emotional or moral issue, helps reduce guilt and anxiety,” Jensen says. 

2. Educate your support system 

D-MER is not a well-known phenomenon, and it may be hard for people around you to understand. Cortez says sharing your D-MER experience with your partner, family members, and friends can help boost support and understanding. Additionally, research shows that partner support can help alleviate D-MER symptoms.

You can send them articles like this one to help them understand the science behind D-MER. 

3. Prioritize self-care 

To best take care of your baby, you must first take care of yourself. It’s crucial to take care of your physical health. Cortez recommends:

• Drinking plenty of water during milk letdown
• Eating a balanced diet rich in nutrients
• Reducing caffeine intake

Relaxation techniques are also great for self-care. Cortez suggests:

• Deep breathing
• Mindfulness meditation
• Listening to calming music
• Skin-to-skin contact with your baby

4. Get enough sleep

Although it’s easier said than done when you have a new baby, getting enough sleep is critical for your health. The International Breastfeeding Journal reports that sufficient sleep reduces the frequency of D-MER symptoms. 

5. Use distraction techniques 

“The feelings experienced with D-MER are brief, so finding ways to distract yourself can be extremely helpful,” Cortez says. “Watching your favorite TV show or movie, reading, eating a snack, or talking to a friend are all helpful ways to distract from the emotions that may occur during letdown.” Experiment with different distractions during milk release and see what works best for you.

6. Lean on support

Social support is key during times of mental health hardships. Having adequate support can help keep your spirits lifted. “D-MER support groups, online forums and communities, and familial support can provide validation and care,” Cortez says. 

Connecting with other D-MER mothers provides a sense of understanding and solidarity that can help you feel less alone in your struggles. 

7. Pump your breastmilk

Pumping may help some mothers find relief from D-MER symptoms, research suggests. For example, you might find that you experience milder symptoms when you pump versus when you directly breastfeed your baby.

8. Consult a lactation professional 

Lactation professionals help women deal with all sorts of breastfeeding-related difficulties, including D-MER. “An International Board Certified Lactation Consultant (IBCLC) can provide guidance on breastfeeding techniques and offer emotional support,” says Cortez. A breastfeeding counselor can help normalize your experience and offer personalized guidance. Plus, they can assist with any other concerns related to milk supply or milk production.

How Charlie Health can help

If you are a new mom struggling with D-MER, postpartum depression, or both, Charlie Health can help. Our virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for people dealing with serious mental health challenges.

We offer a specialized maternal mental health program for perinatal and postpartum mothers. The program provides both evidence-based individual therapy and group therapy. Virtual IOPs allow new parents to address their mental health struggles from the comfort of their own home. We also offer medication management if antidepressants such as SSRIs or SNRIs are a good fit for you and your treatment plan.

With this kind of support, you can take control of your mental health during the postpartum period. Fill out the form below or give us a call to start your healing journey today.