When I had my first child six years ago, I was grateful breastfeeding turned out to be, for the most part, a smooth ride.
After a visit with the hospital lactation consultants, who showed me the best breastfeeding positions and gave me the support I needed, I was on my way, and continued to breastfeed exclusively for the next 12 months.
In those early months, though, I’d experience something odd—and often frightening—that I never told anyone about. When my daughter latched on and my milk let down, an intense feeling of anxiety, panic and doom would wash over my entire body. For a brief moment—about 20 or 30 seconds—I had a sudden irrational fear that something bad was going to happen.
And as quickly as the feelings came, they went.
It was always unsettling and, at times, scary, but because I had struggled with anxiety for as long as I could remember, I chalked it up to biology and hormones.
When I gave birth to my second child two years later, I wasn’t surprised those same feelings surfaced once again. It was still unsettling, but thankfully, it didn’t affect my ability to breastfeed her for 13 months.
Yet it continued to nag at me, and as a health journalist, I wanted to know why. I’d often write about breastfeeding, and when I asked my sources if this was common, most of them had no idea what I was talking about. Then one day, I spoke to a lactation consultant and she told me what I had experienced was real and it had a name: D-MER: Dysphoric Milk Ejection Reflex.
What Is D-MER?
D-MER is a “glitch” in the milk ejection reflex—the mechanism that allows breast milk to flow—and can cause negative emotions for anywhere from 30 seconds to two minutes at milk letdown, according to Alia Macrina Heise, IBCLC, CLE, CPD, a lactation consultant in Naples, New York, who is credited with pioneering research on D-MER.
In order to make breast milk, dopamine (a hormone and neurotransmitter in the brain linked to feeling pleasure) levels must fall for prolactin (the hormone that helps women produce milk) levels to rise. But with D-MER, scientists believe too steep of a drop in dopamine during milk letdown leads to a chemical imbalance that triggers D-MER.
But since the condition was identified only about 10 years ago, there isn’t much research on D-MER, and what is known is based on individual cases and anecdotal evidence. Even estimates on how many women have it are unclear, but Macrina Heise says, “The majority of mothers who breastfeed don’t have this experience.”
What Are the Symptoms of D-MER?
Women with D-MER may experience anxiety, coupled with irritability, dread, panic, a feeling of homesickness, anger, paranoia or sadness.
D-MER is not experienced the same way by all moms; it’s defined on a spectrum of mild, moderate and severe, and is classified into three groups: despondency D-MER, anxiety D-MER and agitation D-MER.
In severe cases of D-MER, thoughts of self-injury and suicide may occur, but Macrina Heise stresses these feelings are short-lived. “I’ve never heard from any mother who was so distraught that it spiraled into some other kind of mental health disorder,” she says.
Symptoms of D-MER usually disappear within three to six months of breastfeeding but severe cases can last beyond the first year.
Unlike postpartum depression or anxiety, D-MER is physiological, not psychological, meaning it’s your body’s physical response to a chemical change in the brain rather than a condition that affects your mental health. So a history of anxiety, depression or a genetic predisposition for mood disorders doesn’t seem to increase a mom’s risk.
That said, women who have D-MER with their first child are more likely to have it with subsequent children, but that’s not always the case. “There are plenty of mothers who may not have it with their first or second and perhaps will have it with subsequent children,” Macrina Heise says.
How to Treat D-MER
For most women, treatment isn’t necessary, especially once they know the medical issue they’re dealing with. When a woman “understands that the situation is temporary and not founded in reality,” Macrina Heise says, “[she’s] able to cope better despite [her] discomfort. Generally, it’s not a reason to wean or fear breastfeeding.”
And while there’s no medically approved treatment for D-MER, some women have found taking vitamin D or rhodiola root supplement, an herb touted for helping with stress and fatigue, improved their symptoms. Scientists believe the key is dopamine, and an early case study found the antidepressant Bupropion and (interestingly) chocolate ice cream both spiked the brain chemical and helped improve symptoms of D-MER. If you suspect you have D-MER, Macrina Heise advises to always seek out treatment under your doctor’s supervision.
What I Learned
It wasn’t until years after I stopped breastfeeding that I learned about D-MER, but had I known while I was breastfeeding, I wouldn’t have done anything different. Studies show nearly half of breastfeeding women throw in the towel by six months and I was grateful I was able to nurse for as long as I did.
I won’t lie and say breastfeeding didn’t come without its challenges. In the early months with my first child, my breasts were engorged and leaking and I always felt like I was “on call.” With my second child, everything was different. I worried about low milk supply, my daughter had tongue-tie and I had a bout of mastitis. Yet breastfeeding is just like anything else that comes with being a parent—some days you feel like super mom while others you have no idea what you’re doing. Of course, you're going to give it your all anyway.
Julie Revelant is a health journalist and the owner of Revelant Writing, LLC, an inbound consultancy that provides content marketing, copywriting and brand journalism services for the healthcare industry. Julie is passionate about health, nutrition and fitness, and helps parents raise healthy kids who crave healthy food at julierevelant.com.
Published September 2017