Dysphoric Milk Ejection Reflex

What it is?

It is a flood of negative emotions that occurs at the beginning of each breastfeeding session, just before the milk release.

D-MER is usually described as feelings of hopelessness, homesickness or wistful, of panic, paranoia, self-loathing, dread, anger or irritability, a sense of impending doom, or even thoughts of suicide. Within about a minute, these feelings vanish... only to come back at the beginning of the next nursing.

The cause is unknown, but there are several hypotheses. Oxytocin, prolactin, and dopamine are the main players in milk production and release. Other pituitary, thyroid, and adrenal hormones and insulin, are also involved. Mother's experiences, published articles, and my own work with a similar type of dysphoria have given me confidence that the Dopamine Hypothesis is the most likely.

The Dopamine Hypothesis.

  • D-MER s not a psychological response to breastfeeding, but a physiological response to milk release.

  • It can resemble depression, but women have all the unpleasant feelings described above only at the beginning of nursing

  • Those unpleasant feelings may be the result of a too-deep drop in dopamine at milk release.

Why is it happening?

According to a very simplified version of the Dopamine Hypothesis, in response to suckling,

  • oxytocin level rises to start the milk ejection reflex (not shown on the diagram)

  • dopamine level falls, allowing for prolactin release, which drives milk production.

Here are a few places to read further:

Dysphoric Milk Ejection Reflex Help

Dr. Mark Shukhman's interest in D-MER was inspired by the works of Alia Macrina Heise and Diane Wiessinger, known in the field of lactation. For many years, they have been not only collecting data, but also gaining practical experience by being personally involved in helping D-MER sufferers. By the time Dr. Shukhman was introduced to D-MER, he had already developed a strategy for the treatment of a very similar intermittent dysphoria, postcoital dysphoria. The strategy is outlined in his chapter in "The LDN Book" and in his presentation at the LDN Research Trust 2016 Conference. The two dysphorias have striking similarities and, likely, similar mechanisms, which means that the same treatment approach may work.

Low-Dose Naltrexone - a promising treatment.

We will offer you a few strategies for D-MER. Starting a Low Dose of Naltrexone (LDN) makes a lot of sense. Even when it is used in its usual dose, naltrexone it considered safe in breastfeeding. You need to worry even less when you use a low dose, which is only 1% to 10% of the usual dose. LDN improves your body's response to endorphins, your naturally occurring opiates. We think that, with LDN's endorphin boost, your dopamine level will not drop as rapidly or as drastically.

Click HERE to read more about LDN and other treatment strategies for D-MER