15 Nov When breastfeeding makes you feel sad: Exploring Dysphoric Milk Ejection Reflex (D-MER)

By Anchen Verster – Registered nurse and midwife, SA certified perinatal educator (SACPE)

I sat across from a new mother as she explained to me how hopeless and rejected breastfeeding made her feel. As soon as her baby latched and the milk started flowing she would have an overwhelming feeling of loneliness and even a desire to pull her baby away from her breast. Seconds after the feed was over the feelings would subside. She explained how her symptoms changed during feedings depending on whether it was day or night, how tired she was or if she hadn’t been taking in enough fluid. During the day at breastfeeds she would feel a sadness or loneliness. At night the feelings would change to severe anxiety and a ‘skin crawling’ feeling.

When you breastfeed the suckling at the nipple and prodding of the baby’s hands against your breast sends a message to the brain via nerves signaling the release of the hormone Oxytocin from the Posterior Pituitary gland (Milk Ejection Reflex). Once released it reaches the little muscles surrounding your milk producing cells and causes them to contract releasing the milk into the milk ducts giving your baby access to the milk. This happens multiple times during a feeding session but mothers may only be aware of the first one or only aware it has happened by the baby’s more regular swallowing. The sensation of Oxytocin release has different effects on mothers. Some mothers will say it makes them feel very drowsy, others say it gives them an overwhelming feeling of love and affection for their baby and others report feeling calm when their baby is breastfeeding. Oxytocin also helps the uterus contract thereby controlling bleeding. You may even feel these contractions when you are breastfeeding especially during the first few days after birth.

Oxytocin isn’t only present in the perinatal period, but has functions at other times of life and is present in the male and female hormonal profile. These are some of Oxytocin’s ‘other’ functions:

• Helps induce sleep
• Fosters generosity and trust
• Facilitates bonding in men and women
• Helps us to process social information
• Helps the movement of sperm and the production of testosterone in men
• Plays a role in sexual arousal
• Makes us more open to touch

So, usually breastfeeding is related to these positive sensations mostly caused by oxytocin release but also influenced by other hormones.

For some mothers the feelings and sensations experienced during breastfeeding have the opposite effect.

Dysphoric Milk Ejection Reflex (D-MER) describes the phenomenon where some moms feel a mild or severe “drop” in their emotions as the Ejection Reflex is stimulated. A M Hesier described her feelings when breastfeeding and eventually started a website called ‘d-mer.org’. She was inundated with mothers with the same or similar experience but who were too scared to speak out for fear of being diagnosed with postnatal depression when they knew that is not what they were suffering from. We’re always told that breastfeeding is this wonderful experience (in the absence of sore nipples or feeding problems) so these feelings during feeding are very distressing and isolating to a mother. Most mothers can’t imagine that another mother may be experiencing similar symptoms so they often keep quiet about or simply give up breastfeeding. Mothers express emotions such as anger, anxiety and depression but within a few minutes the feelings subside. Other feelings experienced are home-sickness, abandonment, agitation, feeling repulsed or feeling wistful.

Researchers and lactation consultants postulate that although Oxytocin is initially one of the key hormones of lactation and is responsible for the positive feelings listed previously, it seems more plausible that the symptoms experienced by mothers with D-MER during the ‘Let down reflex’ is related to a sudden drop in Dopamine levels when Oxytocin is released. Most of the available information we have about D-MER is related to case studies and some preliminary studies but so far this hypothesis seems to be confirmed by symptoms and interventions.

There is no absolute cure but many mothers find that just knowing that it is a documented phenomenon with physiological explanation is a great relief. Finding support with other mothers will also help.

The mom who I described in the beginning of this article found that taking extra Omegas, multivitamins and vitamin B helped. Increasing fluid intake and making sure she had enough sleep also made a difference. Her partner did one feed a night with expressed milk and this gave her an extended sleep time during the night.

Mothers who have D-MER often have copious amounts of milk and thus potentially ‘let-down reflexes’ at non-feeding times. It may be useful seeing a Lactation Consultant to help regulate the supply and thus limit the number of ‘let-downs’. Some mothers find the symptoms so overwhelming that they choose to stop breastfeeding. Ideally we’d like to help each mother to find tools to cope even though the symptoms can’t be eliminated completely.

If you are experiencing D-MER, keep a two week diary of the severity of the euphoria and what circumstances or tools helped or made the symptoms worse. You can score the D-MER symptoms for each feed from 0 to 5; 5 being worst feelings and 0 being no Euphoria with feed. For each day list any food or experiences that you had during the day to see if you can draw any conclusion with your specific ‘helps’ or ‘hindrances’.

Mothers list tiredness, stress, dehydration and caffeine as factors, which make the Euphoria worse. Staying well hydrated, getting plenty of rest and exercise can thus improve symptoms. Distraction tools such as music, television, reflexology and aromatherapy may help in decreasing the experienced sensations. Mothers who use Selective Serotonin Reuptake Inhibitors (SSRI’s) often experience significant relief in their symptoms. These are a group of antidepressants that have an effect on the brain’s chemistry and messaging system. Your doctor will prescribe a medication that is safe for your baby as you are still breastfeeding. Usually the benefit of using medication and keeping the baby on human milk far out-weighs the risk and long-term disadvantages of putting a baby onto cows-milk formula. You may find that the medication has an effect on your milk supply. Again, work with a Lactation Consultant to help you overcome this difficulty.

There are some foods like bananas, which are “rich” in dopamine, but this dopamine doesn’t cross the blood-brain barrier so it cannot change the concentration of dopamine in the brain. Other foods are ‘metabolic pre-cursors’ to Dopamine but again there is no evidence to show these foods can relieve symptoms of D-MER. Little is known about herbal medication and the treatment of D-MER and the concentration of Herbal medication in breast milk so it is currently not a well-documented treatment option. Many moms will notice that their symptoms decrease once their period returns.

One of the biggest helps for mothers suffering from D-MER is knowing that it is a real physiological ‘dysfunction’ and that other mothers have similar symptoms. It is not a “mind over matter” phenomenon where you are able to think your symptoms away or ignore them. It is also not a form of postnatal depression. Many mothers have found ways to cope often including medication to enable them to continue their breastfeeding relationship with their baby.