Dysphoric Milk Ejection Reflex

Ever sat down to nurse your tiny cherub and, as she starts suckling, felt utterly and completely miserable, just out of the blue? The feeling lasts for, oh, maybe a minute or two. And then, just as suddenly...you're fine again.

 Copyright, used with permission from http://scbirthphotography.com

Copyright, used with permission from http://scbirthphotography.com

Sound crazy? If you regularly feel this way, you probably feel like you are crazy, but there is a name for this ailment and a scientific, though relatively unstudied, explanation.

It's called DMER. If you want the fancy, scientific term, it stands for Dysphoric milk ejection reflex, but for our purposes here, we'll use the abbreviation and just call it DMER.

Simply put, DMER is a very brief dysphoria - a feeling of being unhappy or discontent - right before your milk lets down. And that, my friend, is thanks to all those wonderful hormones that have been hard at work on you since the moment you conceived.

When your baby latches on and starts stimulating your breast, she begins to trigger a milk ejection reflex (MER). It sounds simple, but activating the milk ejection reflex actually starts a complex interplay of hormones. Dopamine, a neurotransmitter, is one of those hormones. Among many other things, dopamine helps control mood. It also stops your breasts from spewing milk left and right willy nilly because it inhibits the release of prolactin.

Why is that important? Like dopamine, prolactin has many functions but the one we are interested in here is the stimulation of milk production. Prolactin rises in your body when the milk ejection release is triggered - even before you start to let down.

Finally, there is oxytocin, your old friend from pregnancy, labor and birth.Oxytocin causes cells within your breast to contract, which in turn forces the milk into the ductules and out the nipple.

Dopamine = inhibits prolactin production

Prolactin = stimulates milk production

Oxytocin = ejects milk from the breast

But wait a minute. If prolactin stimulates milk production but dopamine inhibits prolactin production and both are present in your body, how do you produce and let down milk

And that’s where the tricky part comes in. Dopamine levels have to briefly drop as the milk ejection reflex is triggered (by oxytocin) so that prolactin levels can rise to make more milk. As soon as they do start to rise, dopamine levels quickly stabilize. This is the case for every lactating woman.

DMER occurs when your dopamine levels drop inappropriately. According to a study "...Until more is known, it is the authors' very humble hypothesis that a drop in dopamine either facilitates or parallels each oxytocin spike in lactating human mothers, and that it is this dopamine drop that results in D-MER in susceptible mothers." 

Your dopamine levels stabilize quickly, which is why the dysphoria is so fleeting and, sometimes, maddening.

The discovery of DMER Is fairly new, and there is very little research on it. What we do know is this:

You may experience the feeling of unhappiness at every let down during a single feeding or just the initial letdown at the beginning of the breastfeeding session. It seems that women who have had DMER go on to experience it with each of their subsequent children. The symptoms range from mild to severe, and there are three spectrums of DMER - depression, anxiety or anger.  

It seems that if you have depressive DMER, your primary feelings of dysphoria will be wistfulness, sadness or feeling “down”. Depressive DMER Is often the mildest form of DMER, as anxiety and anger DMER tend to be composed of stronger, more violent emotions. You generally only experience one type of DMER.

It is unclear when exactly DMER dissipates. For mothers with mild DMER, it appears to self correct within three months. For those with moderate DMER, it often goes away on its own in six to twelve months, but sometimes mothers seek treatment. It is hard to know when or if severe DMER disappears on its own because most mothers with this condition are unable to continue breastfeeding.

In short, if you feel suddenly and utterly despondent the moment your little angel starts nursing, you aren't crazy. Your symptoms are real and valid. Don't despair. For many, just knowing "what it is" can be enough solace to get you through DMER. However, that's not enough for everyone. If DMER seriously disrupts your life and your breastfeeding, talk to someone. Get help.

Have you had any experiences similar to DMER? Did you know there was a name for this feeling? Share your thoughts and stories with me in the comments below!

Special thanks to Santa Cruz Birth Photography for the lovely picture! Please check out her Facebook page and website and if you're in the Santa Cruz, CA area think about hiring her for your next birth!