D-MER: Breastfeeding's Ugly Side

Dr. Chapa’s Clinical Pearls.

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. Although research is still evolving, one study Published in 2019 (Breastfeeding Medicine) states that up to 9% of breastfeeding women may experience dysphoric milk ejection, although the true incidence is still unknown. The brief negative feelings range in severity from wistfulness to self-loathing. In Arch Gynecol Obstet, in July 2024, authors published, “Dysphoric milk ejection reflex – a call for future trials”. This is gaining interest in the published literature. The etiology of this is unclear but a new (soon-to-be-released) publication in the AJOG provides some interesting insights into this. This was just accepted for publication on September 18, 2024 and the official release is pending. Haven’t heard about D-MER? Due to a lack of awareness, this phenomenon is easily misdiagnosed as postpartum depression and aversion by many healthcare professionals. A July 2024 Harvard Review in Psychiatry publication called D-MER, “A Novel Neuroendocrine Condition with Psychiatric Manifestations”. This condition is a physiologic tale of oxytocin, milk- let down, dopamine and prolactin, and the fight and flight response. Listen in for details.