Dysphoric milk ejection reflex

Why do I feel sad whenever I start breastfeeding?

In some mothers, the let-down brings strong undesirable feelings including sadness, hopelessness, irritability, or nausea. Some mothers may experience feelings of sexual arousal. The feelings disappear within minutes after the let-down has passed. This experience is called a dysphoric milk ejection reflex. It may settle within months or continue for the duration of breastfeeding. The cause is unknown and there is little research on treatment. Distraction, foods with a strong taste, and knowing that these feelings are short-lived may help. Anti-depressant medication is not appropriate and there is no reliable evidence supporting the use of herbs or other medications.

A) Describing a dysphoric milk ejection reflex

Occasionally mothers may have strong feelings brought on by their let-down. This is called a dysphoric milk ejection reflex (D-MER). Mothers may feel (Cox 2010; Heise 2011; Ureño 2017).

  • Negative or sad
  • Oversensitive
  • Tearful
  • Hopeless
  • Anxious
  • Panicked
  • Irritable or agitated
  • Restless
  • Angry
  • Nauseous
  • Sexually aroused  

One study (Ureño 2019) found that nine percent of the mothers they studied experience D-MER. 

Stronger let-downs will generally cause stronger emotions. D-MER may be present with expression or spontaneous let-downs between feeds.

These feelings disappear within minutes after the let-down has passed.

D-MER may settle within a few months or continue for the duration of breastfeeding. It may occur with only one, some, or each of the mother’s children. D-MER can lead to weaning.

The cause remains unknown but it is undoubtedly related to the hormone fluctuations that happen with the let-down.

This is not postpartum sadness or depression and should not be treated with anti-depressant medication. However, D-MER is more common in mothers with a history of depression and anxiety (Ureño 2019).

B) Dealing with a dysphoric milk ejection reflex

There is little research on treatment. Approaches to D-MER include:

  • Understanding and accepting that this is a response to a hormonal reflex and not a mental health issue.
  • Mindfulness or meditation.
  • Distraction with music, videos, or other pleasurable activities. 
  • Engaging other sensations by:
    • Smelling a pleasant or unpleasant smell.
    • Drinking an item with a strong taste such as a caffeine-free herb tea.
    • Eating an item with a strong taste such as candied ginger, mint candies, or salty crackers.
    • Using sea sickness wrist bands.
  • Staying healthy with a balanced diet, drinking enough liquids, and exercise.
  • Increasing sleep as is possible.
  • Keeping a diary to identify:
    • Triggers, which may include stress, caffeine, and medication.
    • Which approaches are most effective in decreasing symptoms.

There is no reliable evidence supporting the use of herbs or medication. 

References

Cox S. A case of dysphoric milk ejection reflex (D-MER). Breastfeed Rev. 2010 Mar;18(1):16-8
 
Heise AM, Wiessinger D. Dysphoric milk ejection reflex: A case report. Int Breastfeed J. 2011 Jun 6;6(1):6
 
Ureño TL, Berry-Cabán CS, Adams A, et al. Dysphoric Milk Ejection Reflex: A Descriptive Study. Breastfeed Med. 2019 Aug 8
 
Ureño TL, Buchheit TL, Hopkinson SG, et al. Dysphoric Milk Ejection Reflex: A Case Series. Breastfeed Med. 2017 Nov 8