A woman in upstate New York experienced sudden, intense feelings of unhappiness whenever she breastfed, beginning just before her milk let-down reflex and lasting for up to two minutes. The symptoms, later called dysphoric milk ejection reflex (D-MER), appeared during every nursing session for about 18 months and disappeared after she stopped breastfeeding. A 2011 case report helped bring attention to the condition, which may involve changes in dopamine, although its exact cause and treatment remain uncertain.
A sudden wave of negative emotion
About two weeks after giving birth, the woman began experiencing “extreme unhappiness” shortly before milk moved from her milk ducts to her nipple. The feeling could last for up to two minutes and ended suddenly when the baby finished breastfeeding. It returned the next time her milk was about to come in.
The woman was a breastfeeding counselor with the U.S. Department of Agriculture’s Women, Infants, and Children (WIC) program. Until her baby was about 18 months old, the episodes occurred during every nursing session, an average of about five times a day.
Unlike postpartum depression, which can cause persistent sadness, anxiety and mood changes, the woman’s distress was closely tied to breastfeeding. She reported feeling “helpless, hopeless, [and] worthless” only when her milk was coming in. At other times, she felt happy and connected to her baby.
Tracking the symptoms
When the baby was seven months old, the woman began working with a lactation consultant who later became a co-author of the case report. They tracked when the negative emotions began and whether different interventions made the symptoms better or worse.
At the time, the condition had no official name. The woman began calling it “dysphoric milk ejection reflex,” or D-MER.
What might cause D-MER?
The report’s authors initially considered whether fluctuations in oxytocin might explain the symptoms. Oxytocin is released into the bloodstream before the milk ejection reflex during breastfeeding. However, outside factors known to affect oxytocin levels, including tobacco use, did not consistently cause the woman’s symptoms.
The authors then focused on dopamine, a chemical messenger associated with emotional responses. Changes in dopamine and other chemical messengers during lactation have been less extensively studied than oxytocin and prolactin, which are also involved in lactation.
Some activities that appeared to ease the woman’s symptoms, including taking pseudoephedrine for colds, smoking cigarettes and eating chocolate ice cream, are also associated with increased dopamine levels. Acute stress, which can reduce dopamine, made the symptoms worse. Based on these observations, the authors hypothesized that a sudden drop in dopamine before milk production might trigger D-MER.
Image credit: Mayte Torres via Getty Images
Treatment and symptom relief
The woman began taking bupropion, an antidepressant sold under the brand name Wellbutrin that increases the amount of dopamine in the brain. Within one day, her D-MER symptoms were dramatically reduced, and after five days they were almost completely gone.
She stopped taking the medication after a few weeks because of unwanted side effects that were not described in the report. Her symptoms returned afterward.
She then took Rhodiola rosea, a plant that has been used historically in some places to manage depression. Research suggests that compounds in R. rosea interact with receptors for chemical messengers in the brain. However, the National Center for Complementary and Integrative Health says there is little reliable evidence that rhodiola provides therapeutic benefits.
While taking the supplement, the woman said her symptoms were “much milder,” occurring three or four times a day but returning to normal after a day’s rest. She stopped taking it as her daughter grew older and breastfed less frequently. When the child turned 3 and stopped breastfeeding, the woman’s D-MER symptoms disappeared completely.
Growing recognition of D-MER
Before the case report was published in 2011, D-MER was not widely recognized or documented in the scientific literature, and no studies had examined its causes or treatments.
The woman and the report’s co-author created D-MER.org in 2007 to share information about the condition. The site aimed to raise awareness among medical professionals, provide resources and support to people experiencing D-MER, and explain that the feelings may be a physiological side effect of breastfeeding. According to the report, hundreds of visitors had reported experiencing negative feelings while breastfeeding after the site launched.
Many additional case reports have been published over the past 20 years. In a 2025 paper in the European Journal of Obstetrics and Gynecology and Reproductive Biology, researchers estimated that about 14.2% of breastfeeding parents experience D-MER and that one in six stop breastfeeding as a result. The paper had not yet been peer-reviewed.
Dopamine is thought to play a role, but the exact cause of D-MER is not clearly established. There is no definitive treatment. Stress-reduction techniques, such as meditation and breathing exercises, or support from a partner, friend or online breastfeeding group may help some people manage their symptoms.
Related experiences
Short-term negative emotions resembling D-MER have also been reported by women who are not lactating. These anecdotes describe intense negative feelings triggered by nipple stimulation. One online discussion group called the phenomenon “sad nipple syndrome,” according to the case-report authors. Dopamine may also be involved, but the neurochemistry behind the response remains unknown.
Breastfeeding and parenting can involve “emotional peaks and troughs,” the authors noted. However, the negative emotions associated with D-MER are distinct from the normal range of emotions experienced by parents of newborns. If not recognized as a breastfeeding-related phenomenon, they can cause severe distress.
The authors concluded that people with D-MER “remind us all that we still do not fully understand human lactation.”
This article is for informational purposes only and does not provide medical advice.
Source: www.livescience.com