D-MER {No, You Are Not Crazy}

by Mama Bice on March 27, 2013

Newborn Nursing

We all hear about the joys of breastfeeding. The bonding, the flow of love hormones, and the feeling of accomplishment that often comes to mothers upon reaching goals. Breastfeeding can be tough the first weeks of your baby’s life (or longer), but after that it is smooth sailing right?

This promise of positive emotional connections to breastfeeding is true for the majority of women who breastfeed. But there is a small population of women who experience just the opposite – for seconds to minutes – every time their milk lets down. It is not a physical sensation (such as nausea or pain, which can happen with strong letdowns) and it is not a psychological reaction to breastfeeding (not an aversion or part of PPD or baby blues). It is also not related to past abuse or history. It is a purely hormonal response that is independent of any other stimulus.

D-MER stands for Dysphoric Milk Ejection Reflex.To break that down – you get a feeling of dysphoria (negative emotions) just as your milk “ejects” (lets down) and it is a reflex – meaning the mother cannot control this. It can come in degrees – from feeling disconnected to feelings of self-loathing. There is also a spectrum of types of emotions the mother can feel – which are fully explained here.

So what causes D-MER in the first place? Preliminary studies suggest that the natural drop in dopamine at the start of a feeding, which happens so that prolactin can rise, is sharper in women with D-MER. Dopamine is the mood “stabilizer” of our bodies and prolactin is the hormone mainly responsible for milk production and let down. Normally, this small drop in dopamine is never noticed by mothers and it stabilizes again a few moments after the initial let down of milk. But in D-MER mothers the drop is larger, faster, and noticable in the wave of emotions that wash over them right before and as the milk lets down but quickly dissipates as the milk begins to flow.

Nursing d-mer

The treatments, both natural and medical, are based on the assumption that the dopamine drop is the cause of D-MER. Some of the treatment suggestions include:

  • Education – many times a woman with mild or moderate D-MER is able to manage the episodes better simply by knowing what is happening and that they are not “crazy”. Mild to moderate cases also tend to resolve on their own within 3-6 months.
  • Tracking your episodes. How often do you have them, and what were you doing before the feeding or let down? Does pumping effect you the same as feeding at the breast? Do you get D-MER with spontaneous let down (you know, the kind where you hear a baby cry in the store or watch a sappy commercial). Things like stress or dehydration can also aggravate the condition, so it is important to note those in your log.
  • Herbs used to treat D-MER: (ALWAYS consult with your care provider first)
    • Rhodiola or Golden Root: this builds dopamine in the body naturally and has a marked effect on D-MER.
    • Evening Primrose Oil: increases levodopa in the body, which converts to dopamine.
    • Ginkgo: helps with blood flow to the brain and may help dopamine flow better as well.
  • Supplements and Diet Changes:
    • B-Complex: B6 is needed for brain function and B-12 promotes dopamine activity in the brain.
    • Adding young Fava Beans to your diet – these contain high levels of levodopa.
    • Other foods which help dopamine production include chicken, turkey, almonds, oats, dark chocolate, yogurt, bananas and several others – full list here.
  • Placenta Encapsulation
  • Acupuncture
  • Distraction – find a way to distract yourself for the start of the feeding. Reading, TV, and talking on the phone, etc.
  • Exercise can naturally increase dopamine and receptors in the brain.
  • Prescription treatments options are available – see options and discussion here.

While there are a few published studies out, the full documents are not available online for free. In any case – the evidence in those studies and even more information is available on this wonderfully helpful site: D-MER.org

The newest edition of The Womanly Art of Breastfeeding has a section on D-MER (which is a great read for those who plan to breastfeed in any case). For those mother’s interested in herbal treatments for D-MER (with consultation from your care provider of course), the book The Nursing Mother’s Herbal by Shelia Humphrey is a great guide to start your research.

Reaching out to a support group, be it on Facebook or a local breastfeeding group is highly recommended as well. And above all – know that you are not “crazy” and you are not alone. You can get through this with support and love. Your choice of treatment, even if that means weaning, is one to research and approach with an open heart and armed with information.

Ashley Nursing

*Pictures shared by Anna M. and Ashley O. Do not copy or use images without permission.

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{ 17 comments… read them below or add one }

christine March 27, 2013 at 7:51 pm

OH my — I never knew this — I still remember that feeling even though its been 36 years.

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Lisa March 27, 2013 at 8:45 pm

This is amazing! I never knew this was a thing, even though I have nursed 3 kids and been around LLL friends for years! I have always had this negative sensation for many months after birth upon my very strong letdowns. This is so interesting!

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Alia Macrina March 28, 2013 at 11:05 am

Beautiful and well presented post. Thank you :)

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Julie Thalmam March 28, 2013 at 3:09 pm

This is interesting, I had never heard this before. I had this too, back when I was nursing and it would have been nice to know it was common. Now that I am menopausal I notice the same feeling just before a hot flash. I wonder if there is a link there? Unfortunately with menopause you don’t get the good nursing hormones kicking in. :( I will have to check out the herbal recommendations. Thanks!

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Amy March 29, 2013 at 12:18 am

I never experienced this in the first year of BFing but when I was about 4 months pregnant with my second baby, I would become angry/frustrated/upset just after my son started nursing, even though I loved having that connection and had hoped to continue nursing throughout my pregnancy (he gently weaned, with a bit of assistance from me around this time. I was so grateful, mostly because I hated how I felt when it used to be such a tender, loving experience). Is this the same thing? I never understood why I felt those emotions.

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Tamara September 21, 2013 at 1:42 am

This sounds more like an aversion, which is common in the situation you are describing. An aversion is still a natural response in your body and not your fault or your imagination. D-MER usually happens just before or at the very start of nursing and lasts for a very brief time — seconds to minutes at the most. It does not continue throughout each nursing session. I hope that helps.

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Victoria March 29, 2013 at 10:52 pm

As soon as I heard about these symptoms, I said, “Yep, that’s exactly what I experience.”

I first heard of this through a friend. Now I am desperately searching for people, like myself, who experience the dysphoria just the same at times other than letdown. My whole life I described the feeling as melancholy and would feel the dips into sadness directly after swimming or showering. It is the exact feeling as with letdown and lasts the same amount of time – 30 sec or so.

Anyone out there?

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Sage April 10, 2013 at 11:01 pm

I’m experiencing this right now every time I breastfeed, and I remember when I was a child/teenager I got this intermittently. Strangest, most uncomfortable feeling I’ve ever had. You are not alone!

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Rebecca September 16, 2013 at 2:48 pm

I get it now while nursing. I did with my first as well, but I also remember it from when I was a kid/teen as well. Then it often presented as an unidentifiable urge/need for something but I had no idea what. I wonder if those of us who had something similar when we were younger just don’t process dopamine as well and are thus more susceptible to D-MER

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Mountain Mamma April 14, 2013 at 8:59 am

There is a facebook support group 500 or more with d-MER for anyone I treated in joining. And d-MER.org is no longer up and running, which is sad because that’s where many of us got our information to help ourselves. Many of us would print things off and bring them tour health providers to help explain what is going on. We feel a need to raise awareness. Every time I get in a discussion about breastfeeding with some of my peers I almost always run into a woman who says she stopped because of the following symptoms … And I know that if she had known it was d-MER, maybe she would have even able to power through, or seek treatment. There is a thought that d-MER is bigger than research suggest and is actually a variation of normal in breastfeeding. From our own independent discussions in our group 500 or more with d-MER, we are finding many things in common with one another that aren’t part of official research. If you are interested in helping us raise more awareness join the group and post your ideas. Thank you so much, January and everyone at Birth Without Fear for posting this article. It is sites like yours where many women come for support already that we need to help us spread the word and save many breastfeeding mommies and babies from the switch to formula before they were ready. Thank you! We with d-MER are very appreciative of this support!

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Rebecca September 16, 2013 at 2:51 pm

Do you have a link for the facebook group?

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Mountain Mamma April 14, 2013 at 9:04 am

Sorry about the typos in above comment. So sorry! The first sentence should say *interested in joining. Not I treated in joining. Sheesh!

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Kitty Fraire July 7, 2013 at 1:55 pm

Thank you for this! I tandem nurse my 15 month old and my 6 week old and started getting this awful irritating feeling when they both nursed. It is where it kind of feels like my nipples are being tickled but the best way to describe it is nails on a chalkboard. It drives me nuts! It lasts for the rest of the feeding, But I don’t get it if just one is nursing. I never had this with my first so I had no clue what was going on. I asked about it on Mamas Milkies Private on Facebook and a couple of moms on there told me what I am going through sounds like D-MER. I then Googled it and this post came up. I am currently working on treating it naturally now that I know 1) I am not crazy and 2) what to fix in my diet and supplements to help. I am hoping I can get it under control soon! I had been feeling so guilty about feeling like I didn’t want to nurse them together (and sometimes I just wanted to give up but I couldn’t bring myself to). All I need is patience to wait for my changes to start working (just started my self treatment today). :)

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Kay Gadoury July 14, 2013 at 12:11 pm

I just checked and found that the D-MER website is up and running!

http://d-mer.org/Home_Page.html

There are also techniques stolen from CBT that can help manage these feelings. I would love to do an evidence-based study on this!

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Jessi Long September 20, 2013 at 2:54 pm

Thank you for this info! I am so relieved to finally be able to identify what I’m going through and knowing I’m not the only one makes it more bearable. I have a 4 month old and work full time, so I pump at work but BF at home. I feel a wave of shame/loneliness/despair each time my milk comes in. It’s hard to cope with at work sometimes! I am determined to keep pumping/BF though. I hope all you other ladies find strength in knowing you’re not alone in this struggle!

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Katrin September 24, 2013 at 9:42 am

Oh this is so encouraging to read! I thought I was losing my mind! The first few minutes of BFing my 2 month old son are just hellish (it’s esp bad in the afternoon for some reason). A huge, rolling wave of sadness just smacks right into me and I feel like lying down and sobbing. I’m overwhelmed by feelings of extreme vulnerability, guilt, and loss… Then they just disappear after a few minutes and all is fine again…until the next feeding. So bizarre. But reading this and other such websites is very helpful. I’m definitely neither crazy nor alone!

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Liv October 14, 2013 at 4:56 am

Wow – I am only 5 months pregnant with my first baby, but I have been experiencing this over the last few weeks whenever my nipples are scratched, squeezed or stimulated. I first noticed it while cleaning a bit of dead skin off my nipple, then again when making love with my husband and he squeezed my nipple – which I used to love! It is absolutely bizarre. I can’t find anything on the internet about it occurring before giving birth though, so I still feel like I must be crazy…!

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