If you are cruising along through pregnancy, you already know that breastfeeding is going to be important. You may be looking forward to a warm and cozy feeling of bonding with your baby during feedings.
But what if the feeling you get is a sinking feeling in the pit of your stomach? A sudden rush of negative emotions (dysphoria) is a recently described reaction that more and more women are describing. This reaction has been given the name dysphoric milk ejection reflex (D-MER). [1-3]
Recognition of D-MER is recent. Articles and a few studies started showing up about 10 years ago. D-MER has not yet been accepted by the medical community as an official diagnosis, but it already has an organization (D-MER.org), and women are coming forward to share their experiences. [1,2]
D-MER is not very common. Before it was given a name, many women probably experienced it and were ashamed to talk about it. Because it is new, there are no reliable statistics on how many women experience it. Women who do experience it give strikingly similar descriptions. D-MER occurs about 30 to 90 seconds before milk release, just before breastfeeding, pumping, or spontaneous milk release. [1-3]
Women will experience a sinking feeling in the pit of the stomach and describe their emotions as anxious, sad, agitated, or hopeless. In extreme cases, women may feel anger or even self-loathing. The good news is that as soon as milk starts to flow, the dysphoria goes away. Unlike postpartum depression, the dysphoria of D-MER does not occur at any other times. [1-3]
For most women, this reaction seems to fade over a few months. For some women, especially women with very strong emotions like anger and high anxiety, D-MER may continue until breastfeeding stops. D-MER does not lead to depression or interfere with a mother’s ability to bond with her baby. The big danger is that the dread of D-MER may make a woman stop breastfeeding. 
What Causes D-MER?
The exact cause is not known, but the general feeling is that D-MER is a natural brain reaction caused by a drop in the brain’s chemical messenger dopamine. Dopamine stimulates the feel-good areas of your brain. Low levels of dopamine lead to dysphoria, the opposite of feel good. Some studies suggest that a drop in dopamine is needed to stimulate release of the breastfeeding hormone oxytocin. 
Oxytocin is the chemical messenger of the brain that stimulates release of breastmilk and gives you a calm and loving mood that leads to bonding. Some women may have an exaggerated drop in dopamine before oxytocin takes over. Once feeding starts and oxytocin flows, the dysphoria disappears. Support for this theory is the observation that foods and activities that stimulate dopamine often work to stop D-MER. 
Treatment of D-MER
There are no approved treatments yet, but the antidepressant bupropion seems to help some women with severe symptoms. Bupropion is a dopamine reuptake inhibitor. It helps levels of dopamine remain in your brain longer. 
For most women, just knowing that D-MER is not a sign of depression, and will not get worse, is enough treatment. Foods that increase dopamine, like chocolate ice cream, bananas, turkey, nuts, and cold-water fish may help. Other tips like avoiding stress, caffeine, dehydration, and fatigue also seem to help. [1,3]
If you experience D-MER, don’t worry, you are not alone. Keep breastfeeding. If your symptoms are severe enough to make you dread breastfeeding, talk to your doctor. You can learn more about D-MER at firstname.lastname@example.org. 
In most cases, just knowing that D-MER is a natural reflex for some women is enough to get through the short period of dysphoria. Treat yourself to some chocolate ice cream and know that after D-MER comes the good feeling of oxytocin and bonding with your baby. [1-3]