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Dysphoric Milk Ejection Reflex (D-MER) (D-

7/11/2011

Marissa McDonald - IBCLC

A special thank you to Shaunte Bruton for sharing her story

7/11/2011

Marissa McDonald - IBCLC

Definition
Little evidence to adequately define! Dysphoria:
a state of feeling acutely hopeless uncomfortable unhappy

Opposite to Euphoria

7/11/2011

Marissa McDonald - IBCLC

Characterised
Surge of negative emotional responses Described as
waves of sadness anger anxiety

More intense at the beginning of breastfeed

7/11/2011

Marissa McDonald - IBCLC

D-MER Is Not
Psychological response An isolated physical manifestation
Nausea or itching with MER

Postpartum depression or postpartum mood disorder General dislike of breastfeeding Breastfeeding aversion"

7/11/2011

Marissa McDonald - IBCLC

How D-MER Manifests Itself DWave of negative emotion:


lasts from shortly before initial milk ejection until baby starts to feed vigorously

Variations in symptoms and individual expression of symptoms Symptoms may:


decrease by the 3rd month may continue for the entire breastfeeding relationship

Breastfeeding, breast milk expression or with spontaneous MER


7/11/2011 Marissa McDonald - IBCLC

The Hormones of Lactation in a Woman with D-MER


Abnormal Dopamine Drop Dysphoria

Triggered Milk Release


Nipple Stimulation Over Fullness of Breast Thinking of Baby or of Breastfeeding

Prolactin Rise

Sustained Milk Production Milk Is Released

Oxytocin Spike

www.D-MER.org 7/11/2011 Marissa McDonald - IBCLC

Management of D-MER DWeaning vs management Education and understanding


D-MER is a medical problem not an psychological problem

Log symptoms
May be aggravated by
stress, dehydration, caffeine.

May be reduced by rest, hydration and exercise

Try to reduce spontaneous milk ejection reflex


7/11/2011 Marissa McDonald - IBCLC

What Makes the Intensities Different


MILD
Often self corrects in the first 3 months

MODERATE
Usually will self correct between 3-9 months

SEVERE
Does not seem to self correct within the first year or more.

Not very disrupting to nursing relationship. Education as treatment is enough.

Somewhat bothersome to mothers even after education as treatment. Some risk to shorter duration.

High risk of weaning. Mothers often want treatment options. Very disruptive to nursing enjoyment.

Is usually Despondency D-MER

Is usually Despondency or Anxiety D-MER

Can be Despondency, Anxiety or Agitation D-MER

7/11/2011

Marissa McDonald - IBCLC

www.D-MER.org

Pharmacological Management
Aim to increase dopamine levels NorepinephrineNorepinephrine-dopamine reuptake inhibitors i.e: Bupropion (Wellbutrin)

Hale suggests caution with its use due to persistent reports that it may suppress breast milk supply
7/11/2011 Marissa McDonald - IBCLC

Counter productive
Avoid dopamine antagonists: Antipsychotics: clozapine, risperidone, olanzapine, quetiapine,
ziprasidone, aripiprazole

Antiemetics: metoclopramide*, droperidol, domperidone* Tricyclic antidepressants: amoxapine


)ylppus klim esaercni ot debircserp netfo *(

7/11/2011

Marissa McDonald - IBCLC

Natural Treatment Therapies


Rhodiola Placenta encapsulation Acupuncture Dopamine made form amino acids Tyrosine and Phenylalanine may be taken from foods or as a supplement
7/11/2011

Fava beans Omega 3s Some herbal supplements Music therapy Hypnosis Counselling Vit B complex

Marissa McDonald - IBCLC

Resources
www.Dwww.D-MER.org Media presentation on above web site Breastfeeding: A guide for the Medical Professional, 7th ed. Lawrence and Lawrence Breastfeeding Answers Made Simple, N. Mohrbacher (2010) The Womanly Art of Breastfeeding, 8th ed. (La Leche League International Book), D. Wiessinger, D. West, and T. Pitman (2010)
7/11/2011 Marissa McDonald - IBCLC

References
Cox,S, 2010, A Case of Dsyphoric Milk Ejection Reflex, Breastfeeding Review, 18(1), 16-18 16Facebook online support web page D-MER. www.D-MER.org www.D-

7/11/2011

Marissa McDonald - IBCLC

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