Treatment of post-weaning depression and dysphoric milk ejection reflex – a scoping review

Abstract While breastfeeding has many benefits for mother and baby, some women experience breastfeeding-associated depressive moods such as Dysphoric Milk Ejection Reflex (D-MER) and post-weaning depression. This scoping review provides an overview of influencing factors and potential prevention and treatment strategies. A systematic literature search was conducted in PubMed, Cochrane Library, CINAHL, and PsycINFO (April 2024). Screening was performed independently by two reviewers using Covidence. A total of eleven studies with data on 670 women were included. Seven of the studies reported data on D-MER, four on post-weaning depression. Studies originated from Tasmania, Egypt, China, Japan, Canada, and the USA. Possible protective factors for the prevention of D-MER included expressing milk, adequate fluid intake and sufficient sleep and rest. Possible risk factors for the development of D-MER include prolonged breaks from breastfeeding, acute stress, caffeine consumption and existing mental illness. In case of post-weaning depression, both pre-existing mental illnesses and the presence of previous mental illnesses in the family were cited as risk factors. Treatments for D-MER included antidepressants, herbal supplements, psychotherapy, and coping strategies like distraction or patient endurance. Post-weaning depression was treated exclusively with antidepressants in the studies. The number of studies on breastfeeding-associated depressive moods is very limited. Seven of the included studies were case reports and case series, four were cross-sectional studies. These studies primarily described cases of D-MER and post-weaning depression but did not explicitly investigate the relationship between factors influencing the development of depressive mood. Nor did they investigate the effectiveness and safety of prevention and treatment interventions. High-quality intervention studies would be important to provide evidence-based support for affected women. Key messages • The number of studies on breastfeeding-associated depressive moods is very limited. • D-MER and post-weaning depression are underrecognized conditions. Better research is needed to support women with evidence-base care.