Spill The Tea, Mama: D-MER

D-MER. Dysphoric Milk Ejection Reflex. No one knows about it. I had never heard of it till it happened to me. So let’s talk about it.

D-MER as defined by d-mer.org is as follows. “Dysphoric Milk Ejection Reflex is a condition affecting lactating women that is characterized by an abrupt dysphoria, or negative emotions, that occur just before milk release and continuing not more than a few minutes.

Dysphoria is defined as an unpleasant or uncomfortable mood, such as sadness, depressed mood, anxiety, irritability, or restlessness. Etymologically, it is the opposite of euphoria.

D-MER is like a reflex. It is controlled by hormones and can not be controlled by the mother. She can not talk herself out of the dysphoria.

The dysphoria a mother feels comes on suddenly before letdown and leaves within 30 seconds to 2 minutes.

She feels the dysphoria before she feels the letdown sensation in her breasts (though not all mothers feel a physical letdown sensation).

Often by the end of the first letdown she feels fine again, the dysphoria is gone.

It can happen for the first letdown of a feeding or for all letdowns in a feeding, depending on the intensity of her D-MER.

D-MER has been linked to an inappropriate drop in dopamine that occurs whenever milk is released. In a mother with D-MER at the time of letdown dopamine falls inappropriately, causing negative feelings.

Milk release itself isn’t caused by dopamine dropping; it’s caused by oxytocin rising. In D-MER, the MER (milk ejection reflex) is a result of rising oxytocin (needed to move the milk out of the breast) but the D (dysphoria) is a result of inappropriately falling dopamine. Dopamine gets involved because it inhibits prolactin (which is what makes the milk) so dopamine levels need to drop for prolactin levels to rise in order to make more milk. Normally, dopamine drops properly and breastfeeding mothers never knew it even happened, in D-MER mothers however, it doesn’t drop properly and causes an instant and brief wave of  a negative emotional reaction that lasts until the dopamine levels restabilize after prolactin has begun it’s rise.”

Whew, that’s a lot to take in but it’s important to know, because for me, I was blindsighted by the sudden rage and panic breastfeeding caused me. At times, it left me with scary images and intrusive thoughts. Other times I would begin to silently cry for no reason at all. I thought something was wrong with me until I learned about the condition.

“Unpleasant” and “uncomfortable” doesn’t begin to describe what D-MER was actually like for me. If I wasn’t forcing myself to sit frozen in place for fear of throwing my baby, who I loved more than life, across the room, I was trying not to peel my own skin off. In addition to this, whether it was residual from the HG or due to the hormones, breastfeeding also caused me mild nausea and an extreme aversion towards food. Luckily, all of these negative feelings (minus the food aversion) only lasted for one minute at most. Sometimes I’d have to endure two episodes per nursing session, but the second was never as bad.

10 months later, our breastfeeding journey is still going strong. I didn’t have the option to supplement with formula due to the fact that my daughter hated it, and honestly, I’m glad I never did. EBF was the best choice for us and our relationship. It was extremely difficult at times, and tiring, but at four months the D-MER finally started to lessen in severity and by six months it was almost completely gone.

During those early months, while in the thick of D-MER, my thoughts honestly were consumed with grumblings of “why me?” And “can none of this be easy?” However, looking back on it now, it only served to make me even stronger. It only served to refine my love and deepen my resolve. One to two minutes out of the hours I have spent breastfeeding my child is nothing. The temporary effects of dysphoria on my mental health was just that, temporary. Had I chosen to wallow, to be afraid, the story would be different.

That’s my advice to any mother who experiences D-MER. The feelings will pass. Don’t feel mom guilt if you have to distract yourself from the emotions as they occur. I used my phone a lot in those early months to help me get through, and it worked. I felt mom guilt at first, but I decided “fed is best” and so we soldiered on. You can still have a wonderful breastfeeding relationship, even with D-MER. It just takes creativity, dedication, and a whole lot of patience.

You can do this mama.

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