Do you feel negative emotions like anxiety or depression at the start of your pumping or nursing sessions? This is called D-MER, or Dysphoric Milk Ejection Reflex. Here are some options for how to manage or treat D-MER at home.
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What is D-MER?
D-MER (Dysphoric Milk Ejection Reflex) is a wave of negative emotions that occurs while pumping or nursing, usually when milk lets down. It usually begins right before a letdown and lasts 30-90 seconds.
Women with D-MER report feeling sadness, anger, anxiety, irritability, dread, nervousness, and/or agitation when their milk lets down.
What causes it?
The thinking is that D-MER is caused by a sudden drop in dopamine right before a letdown. We don’t know why some women experience this, and others don’t.
Even though D-MER results in negative emotions, it is not a psychological problem. It is a physiological issue:
But in a mother with D-MER, when dopamine lowers, it falls too wide or too low or too fast in the central nervous system. When dopamine drops inappropriately in a mother with D-MER, the dopamine receptors that are present in the pleasure center of the brain are deprived of the dopamine they need which results in the wave of negative emotions. (Heise)
Are there any D-MER treatments?
If you have severe D-MER, you may want to consider talking to your doctor about potential medications. Medications that increase dopamine levels may help.
For women with mild or moderate D-MER, it’s recommended that you track your symptoms along with anything that might be affecting it (lack of sleep, dehydration, stress, etc.). This will allow you to figure out what makes it worse, as well as what you might be able to do to lessen your symptoms.
I asked on instagram what helped moms manage D-MER. Below are the top D-MER home remedies that were mentioned.
1. Deep, calming breaths
Many women said that starting deep breaths at the beginning of their sessions until the negative feeling associated to D-MER went away a few minutes into their session helped them get through it.
2. Eating a treat when you start to pump
Eating something small (like a chocolate) helped some women distract themselves during the negative feelings.
(Also, knowing you’re going to get a treat of some kind can help motivate you to pump/counteract the dread of pumping that can go along with D-MER.)
3. Light, enjoyable distractions when you start pumping (watching a funny show, reading a book, that kind of thing)
If eating something you enjoy doesn’t work for you, having something that’s not food-related to look forward to can have the same benefit!
Anything that cheers you up or makes you happy can work well – a light Netflix show you enjoy, a book that distracts you, fun music, etc.)
4. Drinking water while pumping
A lot of women mentioned that staying hydrated and focusing on drinking water helped them manage their D-MER symptoms.
5. Call a friend while you pump
Several women mentioned that calling someone/interacting with someone while they pumped helped them get through the negative emotions associated with D-MER more easily.
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6. Weaning from breastfeeding
If nothing works and you are miserable, weaning is an option. Your mental health and the way you feel are important, too.
The only thing I would caution you is just to be certain that you are ready to wean. If you’re not sure, maybe try dropping a pumping session and see how you feel. If it’s more manageable, you can stick with that for awhile. If it’s not, you can keep weaning.
(More on weaning from the pump here.)
Please feel free to share your experience and whether any D-MER treatments have helped you in the comments!
References
- Heise, Alia Macrina, CLC. “Helping Professionals Understand Dysphoric Milk Ejection Reflex (D-MER)” https://img1.wsimg.com/blobby/go/07432874-d089-423f-97a6-b7fa6a74c046/downloads/1boirob67_102745.pdf?ver=1596636212042
- Heise, Alia Macrina, CLC. “Helping Mothers Understand Dysphoric Milk Ejection Reflex (D-MER)” https://img1.wsimg.com/blobby/go/07432874-d089-423f-97a6-b7fa6a74c046/downloads/1boirob65_701086.pdf?ver=1596636212041
Comments & Chitchat
I scoured forums and blog posts to find one person who cured/helped their DMER by taking a 6,000 IU dose of vitamin D daily. The added benefit is that a sufficient amount of vitamin D passes to breastmilk, making supplements for baby unnecessary! https://kellymom.com/nutrition/vitamins/vitamin-d-and-breastfeeding/
I ordered these drops and have been taking them daily with my prenatal multivitamin which contains 1,000 IU Vitamin D. https://www.amazon.com/dp/B094NXYBGM?ref=ppx_pop_mob_ap_share The drops taste bad so I usually mix them in my oatmeal or put them on toast. The drops are oil based so they separate when put into a beverage. Gross.
It took about four days after starting Vitamin D (8W5D) to notice a significant change in how I feel pumping. Usually I feel more anxious right before taking the drops, so my dopamine levels must decrease throughout the day until I take more. My postpartum anxiety has also gone away, and I feel night and day differently about EP than I did a few weeks ago.
I had DMER with my first and am now pregnant with my second and definitely keeping this in mind as we plan. I had a persistent urge to just throw my baby (or the pump) away and run as fast as I can. It lasted until she weaned, and we are seriously considering formula for the second one to avoid this. It’s a real shame that more healthcare providers don’t know about it! Just letting myself scroll social media or watch TV helped – anything to distract.
So sorry you had to deal with this, Audra!
Hi, I have had a 2 previous breast fed baby’s. This tired baby threw me hard. I had no idea d-mer was a thing untill I looked up angry wile pumping! I’m still having a hard hard time with it. This is the first baby that’s exclusively pump and feed. I never had this problem before this baby. It’s worse some days and manageable others. It takes more than 1/2 my pump destino for it to calm down I have tried everything from eating to watching tv and water. There is days where I can’t function when I pump I just sit and cry, be angry or yell at every one because I’m irritated. Since I found out about this I have been going back and forth on stoping the pumping all together. But then I feel guilty and like im a horrible mom if I do. Help me if you can.
Hi Yvett! You are not a bad mom if you stop pumping. What you are describing sounds particularly severe. You are important, and your mental health is important. Your baby will do great on formula if you stop. You are a great mom, and whatever you decide will be the right decision.
I always get the feeling of anger and needing to punch a wall the whole time I pump. To me it feels like the machine is sexually assaulting me everytime, I didn’t even know about this condition.
So sorry you are dealing with this!
I should also mention I breastfed both my kids a long time, my first was 2.5 when we weaned and I was pregnant with my daughter for the last four or five months and the DMER and exhaustion was just unbearable by that point. My daughter is still going and turning 3 in less than a month.
So I have become quite familiar with DMER but it definitely gets better as they get older. But if you go longer than normal without feeding then the next feed it is usually stronger too. I had tried to meditate during nursing in the early stages with my first but once I realized how awful I felt while nursing and how hard it was to meditate then, I decided not to try them but deep breaths can help, and I find sometimes I just need to clench my body and my face up until it passes. Now I find I mostly only get it when she is nursing on one side and playing with the other side with her hand lol. My son did it too and that’s when I noticed it get worse again after it improved as they got older. I didn’t really want to let my daughter do that because I knew how hard it was when my son did, but I didn’t feel like I could really stop her.
I wouldn’t take anything back really, I’m beyond proud that I have been able to go this far despite dmer but my mental health has definitely suffered and I am looking forward to being done soon, even though I know this is our last child and breastfeeding is a special journey. Even though it’s often hard to really appreciate and connect with it in the moment it is so special to be that comfort and safe space for her when she is scared or sad or hurt. But yea nursing on demand for a prolonged time is probably not generally advisable for dmer. 😅
Solidarity to mamas dealing with this, it was definitely not part of the plan with having babies!! Lol biggest thing I can say is get support and make the best choices for you and your baby. For some that will mean weaning. Just know that the dmer does lesson s the hormones balance a bit more. And if you can keep them from the habit of holding the other side that may help too. 😊
Just a heads up, for me and many others, food is a major NO during DMER. Anytime I’m thinking of a food, often one I normally love, and think “ugh I am NOT feeling that right now” I note realized “Oh. DMER.” And sure enough shortly after I get a milk let down. So eating a treat may not be the best idea, just pay attention to whether it helps or whether you’re forcing it down because you’re thinking it will help. 😊
Also it should be noted that let down happens regularly throughout the day even when not nursing. Before I found out about DMER I hadn’t linked the feeling specifically to breastfeeding because often when I had it I was just walking around doing normal things and would get hit with a wave of dread and almost like a manic restless feeling. I did get it while nursing too but hasn’t linked the two and thought it was postpartum depression/anxiety. It wasn’t until a nurse in the ppd support group I was in asked me about DMER and I paid attention after that and Sue enough every time I got the feeling, my milk would let down shortly after!! I told my doctor about it and she hasn’t heard of it. And she is a maternity doctor! This was in 2017 and it seems like there has been a lot more awareness now but it still isn’t well known enough. I feel bad for any moms out there with no idea what is happening to them.
I had to google feeling disturbed while breastfeeding and found out about Dmer. I was relieved to know I’m not crazy. Water also helps me manage it and eating goldfish and watching a show. Before I found out this was a thing, my husband would go in the other room because I would have to try SO hard to keep it together and not get annoyed with everything.
Hi Alysha! So glad this was helpful and so sorry you’re dealing with this!
I just recently realized this condition exists when I googled homesickness when pumping. I don’t experience it when I’m nursing, only when I’m pumping so I thought it was my body’s response to missing my baby or something like that.
In the early days I would have my husband come in while I was nursing to distract me! I’ve also noticed that water would help as well! At 3 days PP I had D-MER and it induced a panic attack (never had one before in my life! It was so scary!) and spiked my blood pressure so high that I had to go to the ER with a 3 day old baby during COVID.