Breastfeeding is often a time of bonding, but for some women, it brings unexpected and distressing emotions. Feelings that can be associated with something known as Dysphoric Milk Ejection Reflex (D-MER). Understanding D-MER is crucial to providing the right support for affected mothers. Here we’ll dive into what it is and what the available research says.
Many women who breastfeed can describe with longing in their voices how a sense of calm and well-being came over them. And how they could completely disconnect from their surroundings in a way they had never experienced before.
But for one group of women, breastfeeding is instead associated with discomfort, sadness and eventually depression. They can describe how painful and shameful this is, but the fact is they are not alone.
A new phenomenon that has been highlighted in the literature around breastfeeding is something called D-MER (Dysphoric Milk Ejection Reflex).
So, what is this?
In short, women with D-MER describe being overwhelmed by feelings of hopelessness, sorrow and fear when they bring the baby to the breast and feel the milk let down.
“feelings of hopelessness, sorrow and fear”
These unpleasant feelings are often short-lived but can eventually create anticipatory anxiety in the breastfeeding woman. Which in turn can lead to early cessation of breastfeeding and, indeed, the development of depression.
And there is no established way to approach women who describe these experiences.
This means that the phenomenon can go unnoticed by healthcare professionals. Leaving the breastfeeding woman without an explanation for her experience.
In many cases, D-MER is likely misinterpreted as a general aversion to breastfeeding. But such experiences (which involve feelings of discomfort throughout the entire breastfeeding period or even at the mere thought of breastfeeding) differ from D-MER, postpartum depression or anxiety. All of which are distinct conditions.
In an article summarizing the current state of research, it’s suggested that D-MER is likely linked to an imbalance in brain dopamine levels.
Since dopamine is such an important neurotransmitter in our reward system, a dopamine system out of balance can lead to feelings of discomfort, anxiety, and sadness.
It is important to increase awareness of D-MER. So that both women and healthcare professionals understand how these strong negative feelings can arise. And to avoid women affected by D-MER stopping breastfeeding prematurely or suffering from depression, guilt and feelings of shame.
Today, it’s widely accepted that neuropsychiatric symptoms are related to dopamine regulation.
According to my clinical experience, women with neuropsychiatric conditions (such as ADHD, ADD, and autism) often feel worse during the breastfeeding period. And the symptoms described with D-MER are more common than is generally recognized.
The women who choose to continue their ADHD medication during the breastfeeding period often feel better than those who do not.
So far, there are no published studies showing that women who choose to medicate during pregnancy and breastfeeding, choose to breastfeed to a greater extent than those who do not medicate.
It has also not been studied whether D-MER is more common in women with neuropsychiatric conditions than in women without them.
Both of these questions are very important and interesting for us as doctors. In order to be able to guide women with ADHD before and during breastfeeding!
Malin Thorsell, MD PhD, is our new expert on the Letterlife team.
Malin is an obstetrician, gynecologist and the head of BB St. Göran at Capio St. Göran’s Hospital Stockholm, Sweden.
In “Ask the Expert” in the app, you can ask Malin about ADHD medications or anything else related to the time before and during pregnancy, childbirth, breastfeeding and the postpartum period.
Reference:
Schildkrout, B., MacGillivray, L., Raj, S., & Lauterbach, M. (2024). Dysphoric Milk Ejection Reflex (D-MER): A Novel Neuroendocrine Condition with Psychiatric Manifestations. Harvard review of psychiatry, 32(4), 133–139. https://doi.org/10.1097/HRP.0000000000000402
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