Lisa Honan’s panic seized her the first night Alice was home from the hospital. Honan lay in bed, sweating, her heart knocking in dread of the moment her infant daughter would wake and start to cry.

“Every time, I would get up, feed her, change her, then sit there in her nursery, kind of numb. The weirdest scenarios would come to mind: What if we’re driving to the store and we get in a car accident?” recalls Honan.

Then the fantasies grew darker. “What If I hurt her?” Honan wondered. “What if I throw her out the window? I would never actually do it, but my mind was filled with horrible, scary things like that,” notions so terrifying and treacherous that Honan didn’t even confide them to her husband. “I kept pushing along … but inside, I was a mess.”

It was several years later — after the birth of her second child triggered another wave of panic — when Honan finally googled “mothers” and “scary thoughts” and discovered a sisterhood of sufferers, a body of research, and a name: postpartum anxiety.

Postpartum depression, more serious and persistent than “baby blues,” has become more familiar in the last 15 years. But clinicians say postpartum anxiety is depression’s agitated flip-side: a host of physical symptoms and obsessive, often frightening thoughts that affect between 13 percent and 40 percent of postpartum women. Often, the two — depression and anxiety — are entwined.

Postpartum anxiety — and the shame that keeps many women from seeking help for their distress — is the heart of a new book, Good Moms Have Scary Thoughts: A Healing Guide to the Secret Fears of New Mothers, by Karen Kleiman, a maternal mental health expert who established the Postpartum Stress Center in Rosemont two decades ago.

The cover of Karen Kleiman’s “Good Moms Have Scary Thoughts: A Healing Guide to the Secret Fears of New Mothers.”
courtesy of Karen Kleiman
The cover of Karen Kleiman’s “Good Moms Have Scary Thoughts: A Healing Guide to the Secret Fears of New Mothers.”

The book, which combines therapeutic advice with comic-style illustrations and space for journaling, grew from a social media tag, #speakthesecret, in which women anonymously posted the frightening thoughts that chased through their minds as they struggled with sleep-starvation, hormonal swings, and the incessant demands of new motherhood.

“We created this forum on the Postpartum Stress Center’s website to shatter the myth that all mothers feel joyful,” says Kleiman, who collaborated with artist Molly McIntyre to create the book. McIntyre’s comics show the dissonance between what a postpartum woman might say when asked, “How are you?” (“Fine”) and what she’s actually thinking (“I’m overwhelmed. I’m terrified. I’m sleep-deprived. I’m sorry I had this baby.”)

The book aims to normalize postpartum anxiety and to provide a gauge on when to ask for help — from family and friends, a support group, or a professional.

“Motherhood is fraught with anxiety,” Kleiman says. “And we know historically that anxiety is an internal signal that can serve to alert new parents and help them protect their children.” But when that anxiety escalates — when a woman checks her baby’s breathing every 15 minutes, when she calls the pediatrician three times a day, when she can’t stop the torrent of disturbing “what-ifs” — then it’s time to find support, she says.

Karen Kleiman, a maternal mental health expert who established the Postpartum Stress Center in Rosemont and author of “Good Moms Have Scary Thoughts.”
courtesy of Karen Kleiman
Karen Kleiman, a maternal mental health expert who established the Postpartum Stress Center in Rosemont and author of “Good Moms Have Scary Thoughts.”

For Honan, 38, who lives in Swedeland, that moment of reckoning didn’t happen until her second child, Seamus, was 3 months old. She was scheduled to see a concert with friends, her first foray out since the baby’s birth.

“I was completely frozen with fear. I couldn’t leave the house. I was afraid something terrible would happen to him,” she says. She stayed home and woke up at midnight, her heart pounding so fiercely she feared it might be a heart attack. “My husband held my hand and talked me down. That’s when I said, ‘OK, I really need to go see a counselor.’”

Therapy, along with a low dose of the anti-anxiety medication Zoloft, helped tame Honan’s panic. She attended a postpartum anxiety/depression support group and found comfort in talking with other mothers. When anxiety flared, she would remind herself to breathe or walk outside.

Before having children, Honan had seen a therapist and taken medication for anxiety symptoms; she believed her panic was under control. “Little did I know that it would just take another big life change to set it off again.”

That’s typical, according to Penn Medicine clinical psychologist Lindsay Sortor, who specializes in perinatal mood disorders. A history of anxiety or depression makes a woman more susceptible to recurrence in the postpartum period, when she’s also exhausted, coping with newborn needs, and navigating a changed relationship with her partner.

It doesn’t help, Sortor adds, that our culture promulgates an image of the postpartum period as a time of misty-eyed joy — a notion that leads anxious women to hide or underreport their symptoms.

Sara Lima, a mother of three from Mount Airy, felt terrific during her first pregnancy. But once Sofia was born — and especially after the infant spent a week hospitalized for a sepsis infection — Lima couldn’t unclench. “I really did feel like my whole body was buzzing all the time, and I couldn’t sleep.”

When Sofia was 5 weeks old, Lima took her outside and accidentally locked the door behind her. “The sky started darkening, and there was thunder. I was so afraid. I didn’t know what to do. I went down the street crying, knocking on doors.” Eventually, a neighbor welcomed them inside and held the baby while Lima phoned her husband.

To outsiders, Lima looked fine: She had a loving marriage and absorbing work as a tax attorney. It wasn’t until the seventh month of her next pregnancy, when Lima began sobbing in her OB’s office, that she sought help at the Postpartum Stress Center.

There, Kleiman offered perspective and permission to acknowledge that parenting was difficult work. She gave Lima a bracelet of turquoise beads as a talisman, a reminder that her anxiety wasn’t a weakness. Gradually, Lima learned to ask for help — when their third daughter was born, her husband spent nights with the baby in their family room so she could sleep — and to build a routine of self-care that includes a Friday afternoon nap.

The good news, says Kleiman, is that postpartum anxiety is extremely treatable with interventions ranging from exercise and healthy eating to cognitive-behavioral therapy and use of medications that are safe even when pregnant or breast-feeding.

“Now, I have up days and down days,” Lima says. “I always say to new moms, ‘How are you doing? I wish I’d known earlier about postpartum anxiety. I wish I’d known it was OK for me not to be OK.”

Resources for postpartum anxiety

Good Moms Have Scary Thoughts: A Healing Guide to the Secret Fears of New Mothers, by Karen Kleiman and Molly McIntyre. Familius, 2019. $16.99. The authors will conduct a Q&A and book-signing at 6:30 p.m., Friday, May 17, at Shakespeare & Co., 1632 Walnut St.

The Postpartum Stress Center, www.postpartumstress.com, 610-525-7527. Information, support, and counseling for individuals and couples on prenatal and postpartum depression and anxiety.

Penn Center for Women’s Behavioral Wellness, pcwbw@med.upenn.edu, 215-573-8886. Consultation, treatment, and clinical trials regarding a range of women’s health concerns, including during conception, pregnancy, and the postpartum period.

Postpartum Support International, www.postpartum.net, 800-944-4773. Online chat, support meetings, information, and referrals.

National Institute of Mental Health (NIMH). nimh.nih.gov/health/topics/women-and-mental-health/index.shtml. Mental health fact sheets, research, referrals, and clinical trials.