Mom experienced 'extreme unhappiness' only when she breastfed ...Middle East

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The symptoms: About two weeks after her baby's birth, the woman began experiencing intensely negative emotions at every breastfeeding session. These feelings of "extreme unhappiness" would start just before her milk ejection reflex (during which milk moves from the breast ducts to the nipples) and last up to two minutes.

Until the baby was about 18 months old, this phenomenon would happen every time the woman breastfed — about five times per day, on average. Unlike postpartum depression,‬ which can cause persistent feelings of despondency, anxiety and mood swings in new parents,‬ the woman felt "helpless, hopeless, [and] worthless" only during her milk release. She reported that she otherwise felt happy and bonded with her new baby.

The diagnosis: Because the woman's condition did not have a formal name at the time, she began calling it "dysphoric milk ejection reflex," or D-MER.

Next, they looked at dopamine. The chemical messenger's fluctuations during breastfeeding are less studied than those of oxytocin and prolactin, another hormone linked to lactation. However, dopamine levels have otherwise been connected to strong emotional responses. Activities that seemed to ease the patient's D-MER symptoms — such as taking the cold medication pseudoephedrine, smoking cigarettes or binging on chocolate ice cream — are also known to increase dopamine levels. Meanwhile, acute stress, which reduces dopamine, worsened her symptoms.

D-MER differs from postpartum depression in that the feelings of sadness are very specific to lactation. (Image credit: Image taken by Mayte Torres via Getty Images)

The treatment: The woman began taking bupropion (better known by the brand name Wellbutrin), an antidepressant that increases the amount of dopamine in the brain. She saw a dramatic reduction in her D-MER symptoms within a day, and five days later, her symptoms were almost entirely gone.

She took R. rosea three to four times per day, reporting that her symptoms became "much milder" but returned if she skipped a day. As her daughter grew older and the woman breastfed less often, the woman stopped taking the supplement. When the child was 3 years old and no longer breastfeeding, the woman's D-MER symptoms went away entirely.

The patient and co-author of the report created the website D-MER.org in 2007 to share information about the condition more widely. She hoped to raise awareness among medical professionals and to help breastfeeding people who experience this condition by providing resources and support and encouraging them to understand that what they were feeling was a physiological side effect of nursing. Since the site's launch, hundreds of visitors have described having negative feelings while breastfeeding, according to the report.

There is no definitive treatment for D-MER, although some have anecdotally found relief through techniques for stress reduction, such as meditation and breathing exercises, and by seeking support from partners, friends and breastfeeding groups online.

Other dilemmas

Short-lived negative feelings resembling D-MER have also been reported in people who are not lactating. These anecdotal accounts describe intense, negative feelings brought on by nipple stimulation. One online discussion group referred to this phenomenon as "sad nipple syndrome," according to the authors of the case report. As with D-MER, dopamine may play a part, but the overall neurochemistry underlying that emotional response is unknown.

People with D-MER, the authors concluded, "serve as a reminder to us all that we do not yet have a complete understanding of human lactation."

This article is for informational purposes only and is not meant to offer medical advice.

Can you guess the diagnosis in these strange medical cases? Find out with our diagnostic dilemma quiz!

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