A woman in upstate New York experienced intense negative emotions exclusively during breastfeeding sessions, starting just before her milk ejection reflex and lasting up to two minutes. The feelings of "extreme unhappiness" would disappear abruptly when she finished nursing, only to return at the next feeding session. This pattern persisted about five times daily until her child reached 18 months old.
Unlike postpartum depression, which causes persistent mood disturbances, the woman reported feeling "helpless, hopeless, [and] worthless" only during milk release. She otherwise felt happy and bonded with her baby, according to a case report she co-authored.
When her baby was 7 months old, she began working with a lactation consultant to track her symptoms. Together they identified the condition as "dysphoric milk ejection reflex," or D-MER, which at that time had no formal name in medical literature.
The case report authors initially hypothesized that oxytocin fluctuations might trigger D-MER, since the hormone releases during milk ejection. However, external factors affecting oxytocin did not consistently trigger symptoms. They then focused on dopamine. Activities that reduced her symptoms, including taking pseudoephedrine, smoking cigarettes, and eating chocolate ice cream, all increase dopamine levels. Acute stress, which reduces dopamine, worsened her symptoms. The authors hypothesized that an abrupt dopamine drop prior to milk release might cause D-MER.
The woman took bupropion, an antidepressant that increases dopamine. Her symptoms nearly disappeared within five days, but she stopped after a few weeks due to unwanted side effects and symptoms returned. She then tried Rhodiola rosea, an herbal remedy, taking it three to four times daily. Her symptoms became "much milder" but returned when she skipped doses. As her daughter breastfed less frequently, the woman eventually stopped the supplement. When the child turned 3 and no longer breastfed, D-MER symptoms vanished entirely.
The patient launched D-MER.org in 2007 to raise awareness among medical professionals and help breastfeeding people experiencing this condition. Since then, hundreds of visitors have reported similar negative feelings while breastfeeding. A 2025 study in the European Journal of Obstetrics & Gynecology and Reproductive Biology estimated that roughly 14.2% of lactating parents experience D-MER, with 1 in 6 stopping breastfeeding as a result.
The exact cause of D-MER has not been definitively established in peer-reviewed research. No definitive treatment exists, though some have found relief through stress reduction techniques like meditation and breathing exercises, plus support from partners and online breastfeeding groups.