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Management of D-MER

Prescription Treatment

Weaning vs. Treatment
D-MER is an unpleasant, difficult and uncomfortable experience, especially for those suffering with severe D-MER. It has been found thus far, though, that D-MER is treatable. If a mother feels she can not continue nursing because of D-MER it is important for her to consider treatment. The risks associated with formula far out weigh the risks of treatment. On the treatment page many options have been listed and books have been suggested for mothers to reference with their care provider to help understand the safety of these choices. It was an uphill battle getting D-MER "out there" as a recognized condition and the purpose of all that work was never to give mothers a reason not to nurse, the purpose is to encourage mothers who continue on.

Treatment in Summary
For mothers with mild D-MER, education goes a long way in treatment. Many find their symptoms more easily managed once they are aware it is a medical problem not an emotional problem. 

Moderate D-MER can also be reduced using education as treatment.  If this is not enough than these mothers should be encouraged  to track their D-MER  in a log to help them become aware of things  that may aggravate  their symptoms (stress, dehydration, caffeine) and things that may help relieve the symptoms (extra rest, better hydration, exercise.) They should look into lifestyle changes and natural remedies to help them further.

Mothers with more severe D-MER may need a prescription in order to manage her D-MER if she feels she may wean because of it. Thus far, treatments that increase dopamine levels in a mother treat D-MER effectively. If her D-MER is severe, and yet she is not at risk for weaning then using education as treatment, natural remedies and lifestyle changes is the more appropriate course of action.

Education as Treatment
Most mild cases of D-MER end up needing no medical treatment. At first mothers often are very distraught about the feelings they have while breastfeeding and find them to be very disturbing and troubling when they do not understand them, and this is rightfully so. However many mothers with mild cases of D-MER, once they understand the emotions are being hormonally manufactured in their bodies and are not justified emotions, are able to manage their D-MER on their own. It becomes a brief mind game. A mother sits down to nurse and feels horrible. It used to be she asked herself "why do I feel so horrible? What is wrong?" Now, she feels the D-MER she no longer needs to question herself. She can tell herself, "Oh, there it is. Very soon my milk will flow, and then the D-MER will go away." Educating oneself about D-MER, reading other mother's stories, taking part in forum discussion, learning about how D-MER works; all these things help educate and inform a mother about D-MER and help her cope better.

General Guidelines For Mothers with D-MER

Evaluate Milk Supply
A high or ample milk supply may go hand in hand with D-MER but before doing anything to decrease it have a LC help evaluate your milk supply. But if you do have over supply the suggestions from here and here will at least decrease your milk supply enough that you have less spontaneous letdowns, a sign of ample milk, and therefore decrease the number of D-MERs you have in a day.

Chicken or Egg? Which come first - the feelings or the milk release?
Touching, feel good times and food raise oxytocin, as well as some kinds of stress. In these situations a D-MER mother's oxytocin may be raised, triggering a letdown. Part of the letdown includes the precursor of D-MER. This means it may feel like the situations are causing the feelings, which cause the letdown, but that is not the case. Instead it is the situation (of stress or family or food) which causes the oxytocin surge which triggers the milk ejection reflex, which starts with a drop in dopamine which is what causes the D-MER. This happens whether or whether not a mother feels the letdown physically in her breasts, as many mothers don't. So uncomfortable feelings/negative emotions do not result in a letdown. So if a mother is feeling D-MER type feelings on and off throughout her day, unconnected to nursing, the feelings are the sign that the milk ejection reflex has been triggered by either a conditioned reflex (sound of a baby crying) fullness of breast (oversupply or missed a feeding) or by emotion (stress or pleasure.) In these situations it is still D-MER and the feelings are not a valid emotional reaction.

Zoloft and Other SSRI Antidepressants
We have learned a few things in regard to antidepressant use in a mother with D-MER most of which is that mothers with D-MER that have tried SSRI antidepressants due to postpartum depression or anxiety and found they helped their ppd, but seemed to make no impact on their D-MER as they do not seem to affect dopamine activity significantly.

Counterproductive Drugs
There have been several reports of mothers with D-MER having undesirable reactions (feelings of dysphoria) when taking or when administered dopamine antagonists. These are drugs that block dopamine receptors, making dopamine less available to the body. This is counteractive to what a D-MER mother should be doing to treat her D-MER. So at this time it is suggested that an alternative is picked when any of the following dopamine antagonists need to be used:

Antipsychotics: clozapine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole

Antiemetics: metoclopramide, droperidol, domperidone (please note that metoclopramide and domperidone are often prescribed to increase milk supply)

Tricyclic antidepressants: amoxapine