What Is Dysphoric Milk Ejection Reflex? This Breastfeeding Condition Can Mimic Postpartum Depression

Many new parents agree that when it comes to caring for a newborn, there's so much that you don't know you don't know. It's only when you're confronted with the reality of, say, settling a baby into a car seat that you stop and think: "Wait a minute, how am I supposed to do this?" And that's especially true when it comes to breastfeeding. There's so much that goes unsaid regarding the realities of breastfeeding, like the fact that cluster feeding is a thing, and what it feels like to breastfeed, like that breastfeeding can make you feel sad, a phenomenon known as dysphoric milk ejection reflex, sometimes known as D-MER.

"Dysphoric milk ejection reflex is a condition affecting breastfeeding or pumping parents which causes a very sudden and intense flood of emotions as your milk is ejecting," says Shelly Patularu, BScN, a registered nurse and international board-certified lactation consultant. People with it may feel sad or depressed while breastfeeding, or any number of negative emotions.

The condition impacts roughly five to nine percent of lactating people, according to Cleveland Clinic. But it's possible that more people experience it and never report it. In one 2021 TikTok, a doctor shared her own experience with the condition, and the comments were full of people relating.

"I'm literally crying I thought there was something wrong with me for feeling that way," one read. "Wow, I thought I was crazy because none of my friends experienced this. I exclusively pumped and got to 9 months and just couldn't anymore," another said.

This is why it's so important to talk about pregnancy and postpartum health openly — because lack of knowledge and conversation can lead to dangerous and unnecessary stigma. When it comes to dysphoric milk ejection reflex, for instance, there are steps you can take to mitigate the symptoms, which may allow you to breastfeed or pump for longer, if you want to. (Patularu confirms it's generally safe for people with D-MER to keep breastfeeding, but the benefits should always be weighed against any risk related to the lactating parent's emotional health.)

Ahead, a breakdown of what causes D-MER, what it feels like, and the various methods people with the condition can try to help relieve symptoms.

Dysphoric milk ejection reflex (D-MER) causes sudden and intense unhappiness (dysphoria) or feelings of dread right before you release milk, according to Cleveland Clinic. The key marker: it only occurs just before you "let down," and sometimes for a few minutes after. Within 30 seconds to two minutes, the emotions disappear, Patularu says.

In the aforementioned TikTok video, the creator noted she thought the symptoms were related to postpartum depression or anxiety, or the "baby blues," and several commenters related. But D-MER is a separate condition. "D-MER is not a postpartum mood disorder," Patularu says. "It is physical reflex resulting in very brief psychological symptoms."

There is no known cause of D-MER. But research has shown that D-MER is physiological not psychological, so it's not caused by past experiences or repressed memories. "The current theory is D-MER happens as a result of decreased dopamine levels during letdown," Patularu says. Oxytocin is the hormone responsible for milk ejection or letdown, and oxytocin suppresses dopamine. The feelings subside once your prolactin and oxytocin levels return to normal, typically within minutes.

D-MER is characterized by feeling intense, unpleasant, or negative emotions just before your breast milk lets down. The emotions can vary, but common ones that breastfeeding parents with D-MER mention include anger, anxiety, depression, hopelessness, a sense of homesickness or wistfulness, panic, a sense of impending doom, or self-loathing.

There is no treatment for D-MER, but it can be managed through different techniques.

"Try focusing on something in your environment, like looking out the window or keeping your eyes fixed on a picture, while practicing deep breathing," Patularu says.

Other methods she suggests include:

It's also possible that different strategies may work for different people. In another TikTok, a creator with D-MER shared that jumping in water helps relieve her symptoms. In the comments, people recommended techniques that worked for them, including drinking a glass of cold water during letdown, increasing exposure to vitamin D, and exercising frequently.

And plenty of commenters reinforced that it's OK to stop breastfeeding and/or pumping and begin using baby formula if the symptoms are too uncomfortable. It's essential to take care of yourself, so you're able to take care of the baby — even if that means stopping breastfeeding before you'd originally planned.