Dysphoric milk ejection reflex, or when breastfeeding makes you feel sad…

When breastfeeding, there is a release of dopamine, promoted by prolactin and/or oxytocin (the "love" hormone), which can also act directly on brain receptors and has an anxiolytic and sedative effect [1].

Breastfeeding hormones are biologically designed not only to encourage us to breastfeed and to produce enough milk for our baby, but also to make the experience "enjoyable".

Oxytocin is a "nurturing" hormone: when released, it promotes interactions between mother and baby, and produces a calming effect, with a reduction in heart rate and blood pressure.

Researchers have been able to demonstrate a link between oxytocin levels and the degree of attachment between mother and child [2].

It helps mothers to protect their child, and can also trigger fight-or-flight responses when the mother senses her baby is in danger, such as a protective reflex in the event of a threat [3].

Dysphoric milk ejection reflex (D-MER) is a phenomenon that is still little known, yet very real.

Women who experience it feel, just after the let-down reflex, a rush of negative emotions, a sense of depression, and waves of anxiety.

It's something very "hormonal" and uncontrollable.

D-MER occurs just before the let-down reflex, in the first few minutes of a feed. It can occur as soon as the let-down reflex is triggered: at the breast, with a breast pump, or even spontaneously between two feeds or two pumping sessions.

It can also occur several times during the same feed or pumping session, making breastfeeding rather unpleasant. That said, most of the time these negative sensations are only present during the first 10 minutes after the start of a feed.

Some women experience symptoms for a few feeds, others for several days or weeks, or even throughout the entire duration of their breastfeeding journey.

At present, researchers do not know why some women are affected and others are not.

Sometimes this phenomenon will resolve on its own; sometimes it will be necessary to wait until weaning.

Knowing it is not your fault
 

One of the things that helps many mothers facing D-MER is knowing that they are not "going mad", and that they are not alone.
 

And above all, that this phenomenon is not dangerous, and that it means neither that they do not love their child, nor that they are rejecting breastfeeding.
 

Follow a treatment
 

Researchers who favour the dopamine theory recommend taking certain plants such as vitex, broad beans, or mucuna pruriens (velvet bean)*, which may increase dopamine or levodopa levels (subsequently converted to dopamine in the brain)[13].
There is also a medication, bupropion, which increases dopamine levels*.
However, this medication has not been tested in double-blind studies, and it is therefore impossible to rule out a placebo effect, which according to researcher Kerstin Uvnäs Moberg could be around 30%[ 14].
 

It should be noted that dopamine antagonist medications (including domperidone, used to increase lactation) could worsen D-MER [15]*.
*Please do not self-supplement or use herbal remedies without the advice of a doctor or pharmacist. This information does not replace the advice of a doctor or any ongoing medical treatment.

As a natural alternative, our breastfeeding food supplement multivitamins contains a patented active ingredient to support mood and wellbeing, which may help. 

"Reprogramming the oxytocin pathways"
 

The idea for researcher Kerstin Uvnäs Moberg, a specialist in oxytocin, is to help reprogramme its circuits by increasing the sense of security in mothers, and by stimulating its production through skin-to-skin contact, massage... in short, through a sense of wellbeing!

Meditating
 

If you experience RED, meditation can help to calm the associated symptoms. The idea is to focus on your breathing during the feed, and try not to "overthink".
 

As soon as you notice your mind wandering, acknowledge it, and gently bring your focus back to your breathing. This can help you to reconnect with the present moment and let go of the negative thoughts that can sometimes overwhelm you.
 

To help with this, you can download an app such as Headspace, which will allow you to practise guided meditation.
 

Other techniques may also help, such as acupuncture, massage… in short, it is also an opportunity to take care of yourself!
 

Taking care of your diet
 

A researcher has also suggested the role of nutrition in managing RED: they recommend making sure to consume enough protein and healthy fats to maintain blood sugar levels.
 

In some women, breastfeeding can trigger a sharp rise in insulin levels (stimulated by oxytocin), but this response can be modulated by reducing sugar intake and increasing fat and protein intake [17].

To find out more about this topic, have a look at our article onpostpartum nutrition.
 

Letting go
 

Finally, simply learning to let go of any pressure around your milk supply can help — never mind the extra pumping for the freezer stash!
 

By avoiding pumping more than necessary (and there is no need to express milk in the first few weeks — let your milk supply establish itself naturally), you can reduce the symptoms.

The mechanisms behind dysphoric milk ejection reflex are still not well understood.
 

Sometimes the D-MER is so intense that weaning feels like the only option, when you feel overwhelmed by this sense of anxiety and sadness, without understanding why.
 

There are many ways to reduce it, or even make it disappear entirely, including taking care of yourself and practising skin-to-skin contact, which can also help each of us experience our postpartum and breastfeeding journey more positively — D-MER or not.
 

Also read our article on the milk blues or post-weaning depression. This phenomenon, though entirely natural, accompanying weaning and the drop in breastfeeding hormones, is also little known.