Breastfeeding, given its biochemical and physiological basis, is known for its many benefits for both the lactating mother and the infant. Among the many challenges new breastfeeding mothers experience is the feeling of aversion in response to their newborn's suckling which has been termed dysphoric milk-ejection reflex (D-MER). Characterized by intense feelings of dysphoria which may eventually interfere with the mother's ability to breastfeed regularly, evidence suggests both the neurobiological and psychological basis of D-MER in an attempt to explain its complexity. Biologically, breastfeeding is expressed by the intracerebral release of oxytocin, an increased expression of oxytocin receptors in specific brain regions, increased mesocorticolimbic reward region activation, the secretion of prolactin and possibly the inhibition of dopamine. Hence, different theories explain D-MER in terms of disrupted neurotransmitter and hormonal activity. Breastfeeding has also proven to influence mood and stress reactivity in nursing mothers with a potential link with postpartum depression. Psychological theories attempt to explain D-MER from a sociopsychosexual lense shedding light on the significance of mother-infant attachment, the sexualization of the female body and the motherhood experience as a developmental stage in a woman's lifespan. The aim of this review is to provide a literature update of D-MER incorporating both neurobiological and psychological theories calling for raising awareness about the complexity of breastfeeding and for the need for mother-centered interventions for the management of D-MER and other postpartum-specific conditions.

Modern research has proven that the “typical patient” requiring standardized treatments does not exist, reflecting the need for more personalized approaches for managing individual clinical profiles rather than broad diagnoses. In this regard, precision psychiatry has emerged focusing on enhancing prevention, diagnosis, and treatment of psychiatric disorders through identifying clinical subgroups, suggesting personalized evidence-based interventions, assessing the effectiveness of different interventions, and identifying risk and protective factors for remission, relapse, and vulnerability. Literature shows that recent advances in the field of precision psychiatry are rapidly becoming more data-driven reflecting both the significance and the continuous need for translational research in mental health. Different etiologies underlying depression have been theorized and some factors have been identified including neural circuitry, biotypes, biopsychosocial markers, genetics, and metabolomics which have shown to explain individual differences in pathology and response to treatment. Although the precision approach may prove to enhance diagnosis and treatment decisions, major challenges are hindering its clinical translation. These include the clinical diversity of psychiatric disorders, the technical complexity and costs of multiomics data, and the need for specialized training in precision health for healthcare staff, besides ethical concerns such as protecting the privacy and security of patients' data and maintaining health equity. The aim of this review is to provide an overview of recent findings in the conceptualization and treatment of depression from a precision mental health perspective and to discuss potential challenges and future directions in the application of precision psychiatry for the treatment of depression.

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