Dysphoric milk ejection reflex

Signs and symptoms

The lactating woman develops a brief period of dysphoria that begins just prior to the milk ejection reflex and continues for not more than several minutes. It may recur with every milk release, any single release, or only with the initial milk release at each feeding. D-MER always presents as an emotional reaction but may also produce a hollow or churning feeling in the pit of the stomach, nausea, restlessness, and/or general unease. When experiencing D-MER, mothers may report any of a spectrum of different unpleasant emotions, ranging from depression to anxiety to anger. Each of these emotions can be felt at a different level of intensity.

Diagnosis

• D-MER does not appear to be a psychological response to breastfeeding. It is possible for women to have psychological responses to breastfeeding, but D-MER gives evidence of being a physiological reflex.
• D-MER is not postpartum depression or a postpartum mood disorder. A woman can have D-MER and PPD, but they are separate conditions and the common treatments for PPD do not treat D-MER. The majority of women with D-MER report no other mood disorders.
• D-MER is not the "breastfeeding aversion response (BAR)" that can happen to some when continuing to nurse while pregnant. Breastfeeding aversion response occurs upon nipple contact when nursing whereas D-MER is triggered by the let-down reflex, even if it is several minutes after latching.

Management

There is no product that is medically approved to treat D-MER. It has been hypothesized that efforts to raise dopamine may help, and anecdotal evidence encourages a healthy diet limiting caffeine intake and adding supplements.

Emotional support

Awareness, understanding, and education appear to be important. Many people with D-MER rate their D-MER much worse prior to learning what is causing their feelings. Once a mother understands that she is not alone in her condition and realizes it is a physiological condition she seems to be much less likely to wean prematurely.

History

The first documented reference to a hormonally based negative emotional reaction while breastfeeding was found online in a forum in June 2004. Prior to the launch of D-MER.org the phenomenon was unknown, unnamed, misunderstood and rarely mentioned or talked about. The term dysphoric milk ejection reflex (D-MER) came from Alia Macrina Heise who described it in 2007. Case reports and case series have been published on the topic. A 2019 study reported a prevalence rate of 9.1%. An October 2021 review of literature published to that date reported:

Due to poor public awareness of D-MER and the scarcity of evidence-based literature, many mothers may mistake D-MER for postpartum depression, especially given its atypical symptomatic manifestations. Additionally, lactation practitioners and health care providers may have limited recognition of D-MER. Another challenge in managing D-MER is that mental health professionals may lack knowledge about lactation or training in lactation management. This makes it necessary to educate mothers because educated mothers are usually better at handling postpartum situations if they are prepared in advance.

References

References

1. (January 7, 2022). "'It Makes My Skin Crawl': Women's experience of breastfeeding aversion response (BAR)". Women and Birth.
2. (2015). "Breastfeeding E-Book: A Guide for the Medical Professional". Elsevier Health Sciences.
3. (June 2011). "Dysphoric milk ejection reflex: A case report". International Breastfeeding Journal.
4. (2021). "Dysphoric Milk Ejection Reflex: The Psychoneurobiology of the Breastfeeding Experience.". Frontiers in Global Women's Health.
5. (July 2008). "Mesolimbic dopamine in desire and dread: enabling motivation to be generated by localized glutamate disruptions in nucleus accumbens". The Journal of Neuroscience.
6. "Is it Psychological?".
7. (17 June 2009). "For Moms Who Feel Bad Before Breastfeeding, This May Be Why".
8. (5 November 2018). "What is D-MER?".
9. "Specifics of D-MER".
10. (May 2016). "Maternal experiences of embodied emotional sensations during breast feeding: An Interpretative Phenomenological Analysis". Midwifery.
11. Bethla. (13 June 2004). "Strange Feeling". MotheringDotCommunity.
12. "LCs Concur". D-MER.ORG.
13. (March 2010). "A case of dysphoric milk ejection reflex (D-MER)". Breastfeeding Review.
14. (January 5, 2018). "Dysphoric Milk Ejection Reflex: A Case Series". Breastfeeding Medicine.
15. (2019). "Dysphoric Milk Ejection Reflex: A Descriptive Study". Breastfeeding Medicine.