To determine whether individuals who suffer from depression and obesity are able to lose weight and show improvements in mood and cardiovascular disease risk factors following 20 weeks of a combined treatment of cognitive-behavior therapy for depression and behavior modification for weight loss. Participants will be assigned to one of three treatments: 1) cognitive-behavior therapy for the treatment of depression combined with an alternative approach to weight loss, 2) a weight loss intervention combined with a depression support and education , or 3) cognitive-behavioral therapy for depression combined with a weight loss intervention.

Inclusion Criteria

• Female and male participants, with a BMI of 27 kg/m2 to 45 kg/m2

• Age 18 - 70 years old

• Presence of current major depressive disorder or dysthymic disorder

• At least 2 CVD risk factors, as characterized by the metabolic syndrome, including:

  • Elevated waist circumference (males 40 inches or 102 cm; females 35 inches of 88 cm)
  • Fasting blood glucose 100 mg/dL
  • Blood pressure 130/85 mm Hg
  • Triglycerides 150 mg/dL
  • Reduced HDL cholesterol (males 40 mg/dL; females 50 mg/dL)
  • OR medications for these conditions

• Able to comply will all study procedures and schedule

• Able to speak and read English

Exclusion Criteria

• Cardiovascular event (e.g., myocardial infarction, stroke) within the past 12 months
• Use of tricyclic anti-depressants, monoamine oxidase inhibitors or paroxetine, mood stabilizers, or antipsychotic medications. (Note: participants who take SSRI/SNRI may be acceptable, provided they have been on a stable dose of these medications 3 months.)
• Use of weight-loss medications or any medications known to significantly affect weight (e.g., oral steroids) in past 3 months
• Weight loss of 5% or more in past 6 months
• Enrollment in weight reduction program in prior 3 months
• Treatment in individual psychotherapy for any psychiatric disorder in prior 3 months (Note: participants in couples or family counseling will be allowed.)
• Severe depression or severe impairment of functioning as judged by the assessor or PI
• Presence of active suicidal ideation
• Diabetes
• Alcohol/drug abuse/dependence
• Renal/hepatic disease
• Change in thyroid medications in last 3 months
• Pregnant/lactating, within 6-months post-partum
• Current diagnoses, or history within the last 5 years, of anorexia or bulimia
• Psychotic symptoms or hospitalization for a psychiatric disorder in previous 12 months
• Mood disorder NOS, substance-induced mood disorders, mood disorders due to a general medical condition
• History of bipolar disorder
• History of head trauma
• Any changes in smoking behavior in prior 3 months (or plans to change in the next 3 months)
• Plans for bariatric surgery
• Any other uncontrolled major medical problems
• Women who are pregnant