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Understanding D-MER: When Breastfeeding Leads to Unexpected Emotions

Written by Milicent Fugate, MD

Associate Director of the Day Program and Reproductive Psychiatrist

Many parents find breastfeeding a unique and intimate experience that fosters a special bond with their child. However, this seemingly natural process can come with unexpected and distressing emotions for some. D-MER, or Dysphoric Milk Ejection Reflex, is a phenomenon that affects a subset of breastfeeding individuals, leading to sudden and severe mood disturbances during milk letdown. Let’s explore what D-MER is, what it feels like, and the options available for those who experience it.

What is D-MER?

D-MER stands for Dysphoric Milk Ejection Reflex. It’s a condition where breastfeeding individuals experience intense emotional distress during the milk letdown phase. Although the term “dysphoria” suggests a general sense of unease or dissatisfaction, the symptoms of D-MER can vary widely. Some people report sudden waves of sadness, while others may experience intense anxiety, fear, agitation, or even panic. These feelings typically subside within seconds to minutes, but the experience can be profoundly unsettling.

Why Does D-MER Happen?

Despite growing awareness of D-MER, the exact cause remains unclear. Current theories suggest it may be linked to hormonal fluctuations, particularly involving dopamine, which regulates mood. During milk letdown, the body undergoes complex hormonal changes, which might trigger these dysphoric reactions in some individuals. It is unclear why some individuals are impacted while others are not, and more research is needed to understand the precise mechanisms. 

It is important to note that D-MER is a physiological response to hormonal fluctuations during breastfeeding rather than a psychological response. D-MER does not reflect an underlying frustration with breastfeeding or negative feelings toward the baby. Nor does the presence of D-MER suggest that breastfeeding individuals are at higher rates of harming their babies. While D-MER can certainly co-occur with perinatal mood and anxiety disorders, such as postpartum depression or anxiety, it does not represent an underlying mood or anxiety disturbance. 

Living with D-MER: Challenges and Choices

For individuals who experience D-MER, breastfeeding can be emotionally challenging. The abrupt and intense mood shifts can create a sense of confusion and isolation. Individuals with D-MER can often find themselves questioning what it “means” that they are experiencing these emotions while breastfeeding, which can lead to internalized feelings of guilt and shame.

One key approach to managing D-MER is psychoeducation and normalization. Learning about the condition and understanding it’s a recognized phenomenon can help reduce the stigma and self-blame often associated with it. Many individuals find comfort in knowing they are not alone and their experiences are valid.

However, the decision to continue breastfeeding or stop is personal. For some, the distress caused by D-MER is tolerable, and they choose to continue nursing despite the discomfort. Others may find it too overwhelming and opt to cease breastfeeding for the sake of their mental well-being. Both choices are valid, and it’s crucial to support individuals in making the best decision for themselves and their families.

Seeking Support

If you or someone you know is experiencing D-MER, it’s important to seek support from healthcare professionals, such as lactation consultants, therapists, or psychiatrists. While there’s no specific treatment for D-MER, these professionals can offer guidance, emotional support, and coping strategies to help manage the condition.

Online support groups and forums can also be valuable resources for connecting with others who have experienced D-MER. Sharing stories and advice can foster a sense of community and reduce feelings of isolation.


D-MER is a complex and poorly understood phenomenon, but it is a real condition that affects many breastfeeding individuals. By raising awareness and providing support, we can help those affected navigate the emotional challenges and make informed decisions about their breastfeeding journey. Remember, whether you choose to continue breastfeeding or stop, the most important thing is to prioritize your mental health and well-being.

The Motherhood Center of New York: Your partner in perinatal mental health care.

Refer your patients to The Motherhood Center using our online referral form or by calling/faxing your referral today. P: (212) 335-0034 F: (212) 202-4369


Australian Breastfeeding Association:

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