After Alia Macrina Heise gave birth to her third child in 2007, she began experiencing what she described at the time as “postpartum depression that comes and goes.”
As a lactation consultant and mother of three, she knew that’s not how postpartum depression works, but she didn’t have any other language then for what she was feeling.
“It was such a sudden drop in mood. And then everything was fine again,” Heise told HuffPost. For her, the drop in mood typically lasted for about two minutes.
While doing some internet research, she stumbled upon a post in the postpartum depression section of a parenting forum. Titled “Only When Nursing,” it described what she had been dealing with to a T. For the first time, Heise made the connection between the emotions she was feeling and the act of breastfeeding. Because she experienced a lot of spontaneous letdowns — when milk is released from the breast when not nursing or pumping — she hadn’t tied the two things together before.
Heise replied to the post describing what she felt in these moments:
It’s a sickening feeling in the pit of my stomach. There is a strong aversion to food. I don’t feel sad, but I feel “icky and yucky.” It is a feeling I seem to have associated with strong feelings of worry and guilt in the past, because when I first started experiencing the sensation I kept searching for what I was feeling guilty or worried about. It turns out that there was nothing. It was just that same sinking feeling in the pit of my stomach that makes me lose my appetite that I had experienced in the past for these other reasons.
Heise was determined to learn more about this under-discussed phenomenon, which only seemed to be whispered about in online forums, and to give it a name. She connected with renowned lactation expert Diane Wiessinger, one of the co-authors of the eighth revised edition of “The Womanly Art of Breastfeeding.”
Together, they coined the term “dysphoric milk-ejection reflex” — or D-MER — to describe this phenomenon, one characterised by an abrupt emotional drop that occurs right before letdown and lasts for just a few minutes. It can happen during breastfeeding, while pumping or alongside a spontaneous letdown.
“It was such a sudden drop in mood. And then everything was fine again.”
- Alia Macrina Heise, lactation consultant and mum
A 2021 review of existing research about D-MER called it “a common, yet not a commonly researched, condition.” One study looking at the condition’s epidemiology put the prevalence at 9.1% of breastfeeding women.
Much of the data we have about D-MER is anecdotal in nature. Awareness of the condition is still low but is slowly increasing. It’s now beginning to emerge as a recognised phenomenon.
D-MER Is A Physiological Condition — Not A Psychological One
With postpartum depression, the feelings of sadness, hopelessness and worthlessness are persistent over a period of time. With D-MER, however, the negative sensations are fleeting — they dissipate as quickly as they came on.
But how exactly those sensations are experienced, interpreted or felt varies from mother to mother. According to Heise, D-MER exists on three different emotional spectrums: despondency, anxiety and agitation. The intensity of emotion can range from mild to severe.
Mild D-MER on the despondency spectrum — the most commonly reported type — involves feelings of homesickness, wistfulness or just feeling down. On the more severe end, it could include feelings of self-loathing or even suicidal ideation.
On the anxiety spectrum, feelings can range from mild irritation to full-on panic.
The least common spectrum is agitation; on the mild end, that might feel like restlessness and, when severe, could include feelings of rage.
Because research on the condition is limited, it’s not yet well understood. But it is believed to be physiological in nature, rather than psychological, because it’s tied to the milk-ejection reflex, an automatic bodily process. You can compare it to tapping that spot under your kneecap and watching your leg kick out involuntarily.
“D-MER follows the same pattern as any other reflex,” reads D-MER.org, a website Heise created about the condition. “You can tell yourself your knee isn’t going to jerk when you hit it, but it does, just as much the hundredth time as it does the first, and it stops as soon as the stimulus stops. The D-MER reflex involves emotion rather than motion because a hormone shift is triggered instead of having a muscle nerve triggered.”
One theory is that people with D-MER experience an abrupt drop in the hormone dopamine accompanying letdown, which leads to feelings of dysphoria.
Finding Out You’re Not Alone Can Be ‘Extremely Liberating’
Dr. Aisha Rush is an OB-GYN in New York City and the mother of eight children. In retrospect, she says she experienced D-MER with all of her children, but she didn’t learn about the condition until after her last child was born.
For Rush, the flood of negative feelings typically last several minutes into each breastfeeding or pumping session.
“If I was enjoying what I was eating before, once I start pumping or nursing, I don’t even enjoy it,” she told HuffPost. “It almost feels like I just don’t want to eat anymore. Anything I enjoyed, it would almost be like you dread it. It’s almost like you just get depressed instantly.”
Eventually, the overwhelming emotions of D-MER began to affect her marriage, too, causing frequent arguments with her husband. In those moments of dysphoria, even the thought of her husband touching her “made [her] want to be sick.”
Rush also believes her D-MER symptoms were responsible for sending her into a “full-blown postpartum depression” after the births of two of her children, she said.
It wasn’t until her eighth child was born that Rush finally thought to Google “Why do I feel depressed when I breastfeed?” Articles about D-MER came up in her search results.
“I couldn’t believe it: There was such a significant relief,” Rush said. “My heart smiled because I realised I wasn’t crazy. And I realised that all of these years what I’d been experiencing is actually a real thing. It was extremely liberating.”
How To Cope With D-MER
Currently, there is no known cure for D-MER, other than time. Symptoms usually begin within the first several weeks of breastfeeding and subside gradually over time. For some people, D-MER takes a few months to resolve; for others, it may take longer. Some people may decide to wean earlier than they originally planned to because D-MER symptoms are too severe or overwhelming.
However, there are things that can make the condition more manageable. One crucial tool is awareness of and education about D-MER. Too often, people are suffering in silence. They know they’re struggling with something, but they can’t quite pinpoint why or with what, so they don’t speak up.
“Once mothers have the information, they know they’re not alone, they know they’re not crazy. Because that’s generally what we hear first and foremost when a mother finds the information: ‘I thought I was crazy.’ That takes the edge off a lot,” Heise said.
Rush also encourages people to open up about what they’re dealing with. That might mean connecting with a lactation expert from a breastfeeding organization, like La Leche League, who has specific knowledge of the condition. Online support groups can also provide a good outlet for conversations. You can also have conversations with trusted family and friends or talk to a therapist or doctor who specializes in maternal health.
“The one thing women need to do is talk about it,” Rush said. “Because when you’re going through this and you don’t know what you’re experiencing, you feel like a prisoner in your own body, you feel like a prisoner in your own mind, and you feel like a prisoner to this process. It’s almost as if you have this ball and chain you’re carrying around with you.”
To cope, Rush also does skin-to-skin time with her son while she’s pumping, as it provides a good distraction from what’s happening in her mind and allows her to focus on the baby. Other light distractions like watching a TV show or listening to music may provide some relief.
Lifestyle changes such as getting exercise, prioritising sleep and staying hydrated may also help ease symptoms, according to D-Mer.org. If symptoms are severe, prescription medication may be an option. Talk to your health care provider to determine the best course of action for you.