What is D-MER?
"D-MER (Dysphoric Milk Ejection Reflex), she told me, is a specific condition that is often confused for postpartum depression but is distinct in a number of ways. Its defining characteristic is that the intense and often overwhelming negative feelings are confined to a short period directly corresponding to a new mothers breast milk “let down” or milk release."
A few years ago I clicked on a random Facebook post about a cognitive condition called Prosopagnosia, also known as face blindness. Until that point I had no idea that I was seeing the world in a very different way than most people, and that there was a specific condition describing my experience to a T. At once the first 40 years of my life made so much more sense.
Now, twenty-ish years into my family focused Chiropractic career, I’ve seen most of the challenges that pregnancy, childbirth and postpartum present for people but a recent patient experience opened my eyes to how many conditions exist but have yet to make it into the public sphere of knowledge. And not for lack of people experiencing them.
During a session, one of my clients mentioned feeling depressed when she breastfed her new baby and I wondered if she was suffering from Postpartum Depression, however the distinctive characteristic of her experience was that, although it was extreme in nature, the only time she felt it was when she breastfed her baby. Luckily, my wife, Dr. Alyssa Berlin, PsyD has been working with perinatal clients for about 20 years and she had answers.
What is D-MER?
D-MER (Dysphoric Milk Ejection Reflex), she told me, is a specific condition that is often confused for postpartum depression but is distinct in a number of ways. Its defining characteristic is that the intense and often overwhelming negative feelings are confined to a short period directly corresponding to a new mothers breast milk “let down” or milk release. I had a long consultation with Dr. Google to learn more about the specific details of D-MER. In my searches, I came across Alia Macrina Heise, a D-MER expert both as a sufferer and an educator, writer and advocate. The work she has done in compiling data, looking for answers and spreading information about this condition is the leading source of information available today.
We had an extremely informative discussion on my podcast, Informed Pregnancy, and you can listen to that here: https://bit.ly/3zCOelS
Postpartum depression is characterized by classic signs of depression such as depressed mood, severe mood swings, excessive crying, intense irritability and anger as well as difficulty bonding with a new baby, fear that you’re not a good mother, and other related symptoms. Postpartum depression often starts within the first few weeks after giving birth and, like classic depression, is felt all or most of the time over a long period.
D-MER is distinct from postpartum depression because although it shares symptoms – sufferers often describe feeling sadness, dread, anxiety, anger – these feelings are specifically triggered by milk let down and start about 30-90 seconds prior to milk release when a mother’s breast releases milk during feeding, pumping or spontaneous milk ejection reflex (MER.) These feelings usually last no more than two minutes, returning with each individual letdown. The rest of the time, when the nursing mother is not having letdown, she feels fine with no reported symptoms of depression.
Also unlike postpartum depression, D-MER is not yet considered a formal diagnosis because there have yet to be formal studies with consistent results. There is however, a wealth of anecdotal evidence much of it collected and synthesized by Alia Macrina Heise and presented in her book “Before the Letdown: Dysphoric Milk Ejection Reflex and the Breastfeeding Mother.”
Addressing the Cause
So what causes D-MER? We actually don’t know yet. One suspect is hormones. During a milk release sufferers experience an abnormal drop in Dopamine (the hormone responsible for feelings of pleasure and reward among other things,) a rise in Prolactin (a hormone responsible for milk production,) and a spike in Oxytocin (the hormone responsible for helping milk release as well as complex social and emotional related chemical reactions.) All three of these actions happening together when a breastfeeding mother’s milk lets down is thought by some to cause the intense temporary feelings of dysphoria known as D-MER.
Whatever the cause, it is a real problem affecting people all over the world and I feel privileged to be able to shed some light and spread some information on such an important subject so sufferers know they’re not alone. When I found out about Prosopagnosia, I was glad to have a name to help me define and explain my experience and that is what I want for those who experience D-MER.
If you or someone you know is experiencing symptoms of D-MER, you can find more information and resources at www.d-mer.org
Dr. Berlin is an award winning prenatal chiropractor, childbirth educator, and labor support doula as well as the host of the Informed Pregnancy Podcast where each week, parents, birth professionals, and parenting experts weigh in on a full range of topics surrounding the perinatal period. Dr. Berlin runs a successful perinatal wellness group in Los Angeles, CA with his wife Dr. Alyssa Berlin with whom he shares four kids, two guinea pigs, and one dangerously smart Aussiedoodle.