Dysphoric Milk Ejection Reflex, D-MER

Some breastfeeding women feel negative emotions such as sadness, depressed mood, anxiety, irritability or anger just before their milk lets down and starts to flow. These emotions can continue for a few minutes. This is known as Dysphoric Milk Ejection Reflex or D-MER.

Dysphoric Milk Ejection Reflex (D-MER) is an abrupt emotional “drop” that occurs in some women just before milk release and continues for not more than a few minutes. The brief negative feelings range in severity from wistfulness to self-loathing, and appear to have a physiological cause.

Rather than forming a continuum like the numbers on a scale, D-MER symptoms seem to form a spectrum of three distinct and different emotions (depression, anxiety, anger) whose intensity varies from woman to woman

[D-MER] is not related to postpartum depression, and it’s not a breastfeeding aversion. D-MER is a specific, abrupt physiological reflex around milk release. Moms with D-MER feel fine throughout the rest of the day; it’s only during milk ejection that the world becomes momentarily bleak.

What causes it?

Physiological not psychological

D-MER is thought to have a physiological cause (a physical and chemical process occurring in the body) over which there is little control. Heise and Wiessinger liken it to a reflex action that you cannot stop:

Imagine tapping your knee to cause a reflexive jerk. Now tell yourself that you are going to resist the reflex with all your will, and tap again. Does your willpower make any difference? This is precisely the problem for the mother with D-MER. The emotions are unavoidable. She can feel them coming, but cannot stop them.

Drop in dopamine

D-MER has been linked to the drop in dopamine (a chemical messenger released by the brain) that occurs whenever milk is released. During the let down, dopamine may fall more than usual in some women or they may be more sensitive to it, and this is thought to cause the negative feelings of D-MER:

an abrupt drop in dopamine may occur when milk release is triggered, resulting in a real or relative brief dopamine deficit for affected women.

Treatment for D-MER

Suggestions for helping D-MER sufferers include using food, herbs or prescription medication that increase dopamine levels. There is a comprehensive discussion of possible treatments on Alia Macrina Heise’s Dysphoric Milk Ejection Reflex website under the headings:

  • Natural treatments—includes a discussion on the herb rhodiola and other herbs, certain foods, B-vitamin complex, acupuncture, or even alternative therapies such as craniosacral or chiropractic therapy, music therapy or hypnosis.
  • Prescription treatments—includes a section on the medication Bupropion.

Heise also recommends trying to track the severity of a mother’s symptoms to identify particular triggers:

mothers should be encouraged to track their D-MER in a log to help them become aware of things that may aggravate their symptoms (stress, dehydration, caffeine) and things that may help relieve the symptoms (extra rest, better hydration, exercise.) They should look into lifestyle changes and natural remedies to help them further.

Mothers with more severe D-MER may need a prescription in order to manage her D-MER if she feels she may wean because of it. Thus far, treatments that increase dopamine levels in a mother treat D-MER effectively.

Seek help and support

Most women with D-MER usually find that their symptoms gradually reduce, sometimes disappearing as time goes on but for others symptoms do not completely disappear until their baby is weaned and they are no longer breastfeeding. Finding out as much as possible about D-MER and seeking help and support can make D-MER more manageable. Two good places for assistance include the D-MER.org website and a Facebook support group run by Alia Macrina Heise.

Clinicians can support women with D-MER in several ways; often, simply knowing that it is a recognised phenomenon makes the condition tolerable.


Dysphoric Milk Ejection Reflex or D-MER, is a collection of negative emotions—anxiety, depression, anger—experienced by some breastfeeding mothers just before they have a milk let down (milk ejection reflex). These feelings last for a few minutes. The cause is thought to be due to a sudden drop in dopamine during let down which can affect susceptible women. There are a number of treatments available that can help.