In October 2015, Emilie Trudell was nursing her newborn son for the first time after his birth when a sickening feeling descended on her like a storm.
“The best way I can describe it is like how you feel the moment you find out a family member has died,” Trudell said. “You get goosebumps, you can’t catch your breath. I tell people, if they’ve seen Harry Potter, it’s like being attacked by a Dementor — this feeling like you’ll never be happy again.”
Alarmed, Trudell alerted the lactation consultant at her hospital, who brushed off the feeling as common among new mothers. After the hospital, the feeling continued every time her son ate, upwards of fifteen times per day.
I tell people, if they’ve seen Harry Potter, it’s like being attacked by a Dementor — this feeling like you’ll never be happy again.”
“It was just this terrible sadness,” Trudell said. “I realized after a few weeks that it was only when my milk let down. It would last for about 90 seconds and then I’d be fine again.” When Trudell recounted the feeling to her OBGYN, another lactation consultant and her friends, all of them chalked the feeling up to postpartum depression. “I’d get so pissed whenever people would say that,” she recalled. “I wanted to shake them. I knew what depression felt like, and this was not that.”
The feeling led her to Google, where she searched “severe sadness during breastfeeding” and found an online community of nursing mothers who described a similar experience: intense feelings of hopelessness, guilt and sometimes even anger – but only during letdown. “They used this term, D-MER, and I thought: ‘oh my God, this is exactly what I’m feeling,’” Trudell said.
Dealing With D-MER
D-MER, which stands for Dysphoric Milk Ejection Reflex, is not a diagnosis recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5); instead, it’s a term commonly used by lactation consultants and others who have studied the phenomenon or experienced it firsthand. Little is known about D-MER, including its prevalence, and the only mentions of it in the medical literature are confined to a few small case studies. But online D-MER support groups are filled with breastfeeding mothers who all claim to have experienced it, said Alia Macrina, a lactation consultant from Naples, NY and moderator of a D-MER support group on Facebook that currently boasts just under 2,500 members.
“It’s very real and can be very disturbing,” said Macrina, who has researched and co-authored case studies on D-MER after she experienced it with her third child in 2007. Although the type and intensity of feeling differs from person to person, D-MER is always characterized by an “abrupt dysphoria” that occurs just prior to milk release and can last anywhere from 60 to 90 seconds. “Mild D-MER seems to be the most common and severe D-MER seems to be the least common, but not by a very wide margin,” Macrina said.
Like others in her support group, Macrina discovered D-MER by Googling her symptoms and finding “whispers” of the condition from fellow lactation consultants on online forums. Though Macrina managed to breastfeed her third child until she self-weaned at age 3, the experience was so impactful she has devoted her career as a lactation professional to spreading awareness.
“I’ve worked now with thousands of women who have experienced this phenomenon,” she said. “It can be hugely disruptive because you go from your life being really good and manageable to feeling like you want to die, just from having stimulated your breast.”
“I’ve worked now with thousands of women who have experienced this phenomenon… you go from your life being really good and manageable to feeling like you want to die…”
According to Macrina, the most widely accepted theory as to why D-MER occurs is due to an inappropriate drop in a neurotransmitter called dopamine. Typically, dopamine – a chemical associated with love and pleasure – drops off slightly in lactating mothers just before milk letdown to allow a rise in prolactin, a hormone responsible for milk production. Macrina and others who have studied D-MER hypothesize that some women instead experience a dramatic drop in dopamine that triggers a brief – yet intense – dysphoria.
Weaning Your Way Out Of Hell
For Kasie Adrian, a first-time mom to a daughter born in March 2019, her experience with D-MER resulted in feelings of intense anger. “It started out with me pumping and then all of the sudden just feeling like I wanted to smash my pump,” Adrian said. “Just out of nowhere I’d start fantasizing about taking my pump out to the street and throwing it in traffic.” Adrian’s lactation consultant told her D-MER was likely the culprit.
Because little formal information on D-MER exists, many with this condition report that well-meaning friends, family, and even medical professionals are often at a loss for how to help. With varying degrees of success, some members of D-MER communities have experimented with cutting stimulants like caffeine and sugar from their diets and supplementing with things like turmeric and magnesium. Adrian was offered Zoloft from her OBGYN, which she declined since she does not feel depressed. “Right now we’re not doing anything for it because we don’t know what to do,” Adrian said.
“[D-MER] isn’t at the top of a lot of researchers’ concerns, because it’s not as life threatening or headline-grabbing as maybe postpartum depression is,” Macrina said. “You can just tell a mom with D-MER to wean her baby, and then the issue seems to self-correct. But moms deserve as much physical and emotional wellness as possible if they want to breastfeed. And if she doesn’t want to wean, she shouldn’t have to.”
“You can just tell a mom with D-MER to wean her baby, and then the issue seems to self-correct. But moms deserve as much physical and emotional wellness as possible if they want to breastfeed.”
Though Adrian is committed to breastfeeding her daughter, now five months, she relies on her online D-MER community for emotional support.
“I’m always wanting to quit on a hard day,” she said. “I have to talk myself out of it, or call a friend, or post on the Facebook group that I’m feeling like I want to quit.” Ultimately, Adrian says, she may eventually switch to formula due to the effect D-MER has on her life and marriage. “If I can’t pump on time, then I just keep having multiple letdowns and it drives me crazy,” she said. “I get frustrated, short-fused. It doesn’t mean I’m never happy, because I am, but it affects how I interact with my husband and how I interact with my daughter.”
No Light At The End of The Tunnel
Emilie Trudell managed to breastfeed for eight weeks with her first son in 2015 and another eight weeks with her second son in 2018. Although she would have liked to have breastfed for at least twelve weeks, Trudell realized she needed to quit after her milk let down when she was driving.
“There was a moment when my seatbelt strap caused enough stimulation that I let down when I was driving and almost had to pull over on the freeway,” she recalled. “Imagine being in a car and getting a phone call and hearing someone died – that’s what it was like. That was the moment where I was like, Emilie, you can’t do this anymore. I knew I was putting myself and other drivers at risk.”
“Imagine being in a car and getting a phone call and hearing someone died – that’s what it was like.”
While Trudell is undecided on whether she’ll breastfeed any future children, Adrian’s symptoms have been so severe that she’s considering growing her family through adoption rather than having any more biological children and breastfeeding again.
“We want more kids,” she said. “But this is hell.”