Breastfeeding and Anxiety: Understanding D-MER

You’ve given birth to a healthy baby and your milk has finally come in. But the actual act of breastfeeding can bring on a whole new level of anxiety for many new moms even if things have run smoothly up until it’s time to nurse. Moms who struggle with breastfeeding can even become so anxious over it that they question whether or not they are good parents. And they aren’t alone. There’s a condition that has been getting an increased amount of attention lately (though still far from enough): Dysphoric milk ejection reflex (D-MER).

What is D-MER?

D-MER is a condition where women who breastfeed develop negative emotions that begin just before the milk ejection reflex. “For some breastfeeding women, when they experience let down, (or the milk starting to flow from the breasts) they may also feel strong negative emotions such as a sense of sadness, anger, anxiety or fear,” says Tamika Simpson, MPH, PMH-C, IBCLC, a digital health coach at Ovia Health. “It’s often described as being sudden and only lasts a few minutes. It’s physiologically related but is not connected to postpartum depression or any psychological response to breastfeeding and it can range in severity. It’s thought to be related to the hormonal response of letdown.” 

How is D-MER diagnosed?

D-MER can be diagnosed based on how the symptoms are described. “If healthcare providers are familiar with this syndrome, they can diagnose it based on the way it is described and the symptoms being experienced, but as of right now there are no known risk factors other than having a past history of having experienced D-MER,” says Simpson. “Theoretically, if the woman has had trouble regulating dopamine in the past, this could potentially be a risk factor.”

Image: Getty

What are treatments for D-MER?  

It appears that this syndrome is related to a response in dopamine dropping suddenly during letdown. “Dopamine, a mood stabilizer is the brain, is supposed to drop as the hormone oxytocin floods in,” says Simpson. “For most breastfeeding moms, they wont notice the dopamine drop. However, for others it may be more sudden or the drop may be steeper causing a noticeable mood change.  Because dopamine will gradually increase, this experience only lasts a few minutes.  For some this experience will be every time they breastfeed until they wean and for others they may see an improvement over time.  Having moms understand what is happening can help with coping and managing those symptoms.”

Bottom line: It is very common to have some anxiety related to breastfeeding, but D-MER is different. “It’s only related to the physiological aspect of dopamine dropping and not related to any feelings of inadequacy or anything else that is psychological, although a mom could experience both.”

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