The hormonal changes that accompany motherhood can be startling- from pregnancy to postpartum to breastfeeding, a lot is going on in a new mother’s body beyond just the physical changes that can leave her feeling out of control and confused as to why she doesn’t feel like herself. One of the conditions that hormones can bring on during breastfeeding is dysphoric milk ejection reflex (D-MER). With D-MER, a woman experiences an abrupt feeling of dysphoria that occurs right before her milk lets down and lasts for less than 5 minutes. This dysphoria is experienced as feelings of depression, anxiety, irritability, panic, agitation, or restlessness. The prevalence of D-MER is estimated to be around 9.1%- a rate significant enough to impact a large number of moms, yet a condition not commonly talked about or understood. 

The condition is described as a reflex because hormones entirely control it and is not controlled by the mother- in other words, it is not your fault! Some basic facts about hormones and the milk ejection reflex:

• Milk is released out of the breast as a result of rising oxytocin
• Dopamine levels decrease to trigger the body to make more milk- when the body is functioning as intended, the mother does not notice this dip in dopamine.
• In a mother with D-MER, the dopamine levels drop way too low, causing a wave of dysphoria.

This is an example where knowledge can be empowering and comforting. I would love to help you wade through the vast opinions and misinformation I’m sure we have all encountered on the internet and look at the facts surrounding your postpartum season. Understanding that dysphoria is a physical reaction of the body rather than the onset of a genuine depression can help prevent the fear and panic that may coincide with such a confusing onset of emotions. Additionally, we can work together to track your symptoms, consider possible action steps to relieve them, and help you maintain your breastfeeding journey for longer if that is your desire. 

By Lauren Hill

MA, LCMHC, PMH-C

Licensed Clinical Mental Health Counselor,                     
Certified Perinatal Mental Health