August 07, 2025

434: Behind The Sessions: Re Release - Breastfeeding, D-MER and Maternal Mental Health

39 minutes

You may think that postpartum depression covers all aspects of perinatal mental health issues that new mothers face. The fact is that there are other kinds of mood changes, some that are talked about and some that are relatively unknown and uncommon. Today’s show focuses on one specific problem that some mothers experience: it’s called D-Mer, which stands for Dysphoric Milk Ejection Reflex.

Heidi Koss, MA, LMHC, is a psychotherapist in private practice in Redmond, WA. She specializes in perinatal (pregnancy and postpartum) mood disorders, birth trauma, sexual abuse, and parent adjustment issues. Heidi has been the WA State Coordinator for Postpartum Support International ⁠www.postpartum.net⁠, and has volunteered for over 20 years with Perinatal Support Washington ⁠www.perinatalsupport.org⁠. She served as past board member for PATTCh – the Prevention and Treatment of Traumatic Childbirth, ⁠www.pattch.org⁠. Heidi is active leading trainings for clinicians on appropriate assessment and treatment options for perinatal mood disorders and birth trauma. She leads monthly clinical consult groups mentoring mental health care providers to develop their competency and expertise in perinatal mental health issues.

Heidi was a co-founder of the Northwest Association for Postpartum Support (NAPS, ⁠www.napsdoulas.com⁠) a postpartum doula organization as well as the recipient of the Doulas of North America (DONA) Penny Simkin Doula Spirit and Mentorship Award. Prior to her psychotherapy career, Heidi was a Postpartum Doula and Certified Lactation Educator for 12 years.

Show Highlights:

Heidi’s work as a mother and perinatal mental health therapist and lactation educator: ”Helping moms with mind, body, and breast”

Why D-Mer is not often talked about and often misunderstood

What D-Mer is: Dysphoric Milk Ejection Reflex. It occurs when milk onset/letdown happens and lasts a few seconds or minutes

D-Mer is a strange emotional phenomenon with negative emotions of sadness, dread, despair, nervousness, anxiety, and irritability

D-Mer can be severe, with fleeting suicidal thoughts and urges for self-harm

The biochemical connection is with two hormones, dopamine and oxytocin, in which they “go rogue,” misfire, or become overactive

No studies have shown who is more predisposed to experience D-Mer

For some women, D-Mer symptoms ease as the baby ages, but some have no change until weaning

D-Mer symptoms might be harder to treat and control in women who already have a diagnosed anxiety or depression disorder

What D-Mer is NOT: nausea, postpartum depression, anxiety, breastfeeding aversion---”It’s NOT the mom’s fault.”

The best treatment is to educate women about D-Mer

How some women can “talk themselves through” D-Mer episodes

Ideas for easing symptoms include rewiring the stress hormones, making positive associations with breastfeeding, and positive touch (massage)

General good habits for life will ease D-Mer symptoms, like mindfulness, meditation, good sleep and self-care, reduced stress, and managing blood sugar fluctuations

To target dopamine, nursing locations should be aesthetically pleasing to make a pleasant mental and physical experience for the mother

Some women find D-Mer intolerable and decide to wean, while some can deal with the symptoms and continue to breastfeed

Wellbutrin works for some women to ease the symptoms

How to find support: Find a lactation consultant and pursue therapy with a perinatal mental health therapist

Resources:

⁠www.d-mer.org⁠

⁠www.heidikoss.com⁠

Email Heidi: ⁠[email protected]

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By Katayune Kaeni, Psy.D., PMH-C

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