When Letdown Feels Like Letdown: Understanding Dysphoric Milk Ejection Reflex (D-MER)
Breastfeeding is often described as a bonding experience—peaceful, sweet, and fulfilling. But for some lactating parents, a wave of intense negative emotion crashes over them just seconds before milk lets down. This isn’t about postpartum depression or general mood changes. This is something different. It’s called Dysphoric Milk Ejection Reflex, or D-MER—and if you’ve never heard of it, you’re not alone.
What is D-MER?
Dysphoric Milk Ejection Reflex is a physiological response that causes a brief but intense emotional dip—often described as sadness, anxiety, irritability, dread, or even hopelessness—immediately before or during the milk letdown reflex. These feelings typically last just a few minutes, coinciding with the hormonal changes that trigger milk flow.
It’s important to know: D-MER is not a psychological condition. It’s not caused by postpartum depression, trauma, or mood disorders. Rather, it appears to be linked to a sudden drop in dopamine—a neurotransmitter involved in mood regulation—when prolactin (the hormone responsible for milk production) spikes during a letdown.
What Does D-MER Feel Like?
Everyone experiences D-MER a little differently, but common descriptions include:
A sudden sinking feeling in the stomach
Intense sadness or emotional distress
Panic or anxiety
Irritability or anger
A feeling of being homesick or disconnected
These feelings usually subside within 30–90 seconds, but they can return with every letdown—including during pumping or even spontaneous letdowns between feedings.
Recognizing the Signs
Because D-MER isn’t widely known, many parents feel confused or even guilty for having such unpleasant emotions during breastfeeding. They might think something is “wrong” with them emotionally or mentally. But awareness is key. If you:
Notice a pattern of negative emotions just before your milk lets down,
Feel fine before and after feedings but low during letdowns,
Don’t experience these emotions at other times of day,
…it might be D-MER.
What Causes It?
While research on D-MER is still emerging, the prevailing theory is that dopamine must temporarily dip to allow prolactin to rise—this is normal—but in those with D-MER, the drop is sharper or more poorly regulated, leading to emotional distress.
D-MER is believed to exist on a spectrum:
Mild: brief, manageable emotions like restlessness or unease
Moderate: stronger feelings like anxiety, irritability, or despair
Severe: intense or disturbing emotions that may cause a parent to avoid breastfeeding or pumping altogether
What Can You Do About It?
While there's no “cure,” there are strategies that can help:
Track your symptoms. Journaling can help you identify triggers and patterns.
Reduce stress. Mindfulness, hydration, rest, and nutrition all support more stable dopamine levels.
Talk to a lactation consultant. They can help you confirm whether what you're experiencing is D-MER and offer coping tools.
Use grounding techniques. Some parents find relief by focusing on a sensory distraction (like holding a cool drink or smelling a calming scent).
Consider supplements or medications. In some cases, supplements that support dopamine (like B vitamins or magnesium) or even prescription medications may be helpful under a provider’s guidance.
You Are Not Alone!
Perhaps the most important thing to know is: D-MER is real, and you are not alone. If you’re experiencing these symptoms, it doesn’t make you a bad parent or mean that you aren’t bonding with your baby. It means your body and brain are reacting in a way that science is still learning to fully understand.
Reaching out—for support, for answers, for validation—is an act of strength.
Resources for Further Support
D-MER.org – the leading resource on Dysphoric Milk Ejection Reflex
International Board-Certified Lactation Consultants (IBCLCs)
Postpartum support groups and maternal mental health organizations