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Defining D-MER:
What It Is

Dysphoric Milk Ejection Reflex is a condition affecting lactating women that is characterized by an abrupt dysphoria, or negative emotions, that occur just before milk release and continuing not more than a few minutes.

Preliminary testing shows that D-MER is treatable if severe and preliminary investigation shows that inappropriate dopamine activity at the time of the milk ejection reflex is the cause of D-MER.

Dysphoria is defined as an unpleasant or uncomfortable mood, such as sadness, depressed mood, anxiety, irritability, or restlessness. Etymologically, it is the opposite of euphoria.

Clarifying D-MER:
What It Is Not

D-MER is not a psychological response to breastfeeding.

D-MER is not nausea with letdown or any other isolated physical manifestation.

D-MER is not postpartum depression or a postpartum mood disorder.

D-MER is not a general dislike of breastfeeding.

D-MER is not the "breastfeeding aversion" that can happen to some mothers when nursing while pregnant or when nursing older toddlers.

Summing-Up D-MER:
What It Does

  • The dysphoria a mother feels comes on suddenly before letdown and leaves within 30 seconds to 2 minutes. 
  • She feels the dysphoria before she feels the letdown sensation in her breasts (though not all mothers feel a physical letdown sensation). 
  • Often by the end of the first letdown she feels fine again, the dysphoria is gone.
  • It can happen for the first letdown of a feeding or for all letdowns in a feeding, depending on the intensity of her D-MER.
  • She may or may not have dysphoria with letdowns when pumping and before spontaneous letdowns, this also is dependent of the intensity of her D-MER.
  • D-MER is like a reflex. It is controlled by hormones and can not be controlled by the mother. She can not talk herself out of the dysphoria.
  • D-MER has nothing to do with nipple contact or with irritation with the sensation of nipple tugging. The mother does not even have to be thinking about breastfeeding (for example with spontaneous letdowns) for the dysphoria to happen when a milk release is triggered.
  • To understand the reflex you must know that when a milk release is triggered prolactin levels begin to rise even before milk has begun to flow through the breasts. Dopamine helps control the secretion of prolactin and so dopamine levels must lower briefly for prolactin to rise. Once prolactin has begun it's slow climb, dopamine stabilizes. This happens to every lactating mother.
  • Dopamine is known for having an effect on moods and in a mother with D-MER dopamine is behaving somehow inappropriately in its drop. It is in this very quick and immediate drop that a mother with D-MER feels her dysphoria. As dopamine levels restabilized, the dysphoria is gone. 
  • The experience of D-MER is variable and a mother will have either despondency D-MER, anxiety D-MER or agitation D-MER. Her dysphoria will fall on it's own place on the emotional spectrum, ranging from homesickness to anger.
  • There are three intensities of D-MER that included mild, moderate and severe. These intensities are determined by the mother's interpretation of intensity, how long the D-MER takes to self correct, how many letdowns per feeding she feels the dysphoria and other criteria.

      Handout for Mothers               Handout for Others                Handout for Professionals

Handouts in Dutch, Russian and German (with Spanish, Italian and French coming soon) are available on this page.


The content on should not be taken as medical advice. We urge you to thoroughly research any of the suggestions mentioned on this site. D-MER, as a recognized and known condition, is still very new and investigation continues but formal research has not yet been organized.