Objective: This study with 31 obese binge eaters (body mass index [BMI] 39.5 Β± 8.6 kg/m 2 [SD]) was designed to assess whether diet counseling with psychological support and imipramine or placebo has an effect on the frequency of binge eating, body weight, and depression during an 8-week treatment phase. This was followed by an open medication-free phase of 6 months of continuous diet counseling with psychological support. Methods: Randomized double-blind placebo-controlled study of 8 weeks followed by an open phase of 6 months. Patients were evaluated in medical visits by a semistructured videotaped interview, psychometric questionnaires, and hematochemical parameters. Results: From Week 0 to 8, a significant reduction in binge frequency occurred in both treatment conditions (7.1 Β± 4.1 to 2.8 Β± 3.0 binges per week [imipramine] vs. 7.1 Β± 4.1 to 5.4 Β± 5.1 [placebo], p < .01). Patients on imipramine lost -2.2 Β± 1.8 kg compared to placebo-treated subjects (+0.2 Β± 3.3 kg, p < .001). On follow-up, only the patients initially treated with imipramine continued to lose weight (-5.1 Β± 2.8 kg [imipramine] vs. 2.2 Β± 6.8 kg [placebo], p < .001 [differences to Week 0]). While both treatment conditions were associated with significant improvements on a rater's measure of depressive symptoms (Hamilton Depression Scale) at Week 8, only the patients treated with imipramine still showed a significant improvement at Week 32. Scores on the Self Depression Rating Scale did not show a group difference but a significant reduction at Weeks 8 and 32, compared to baseline. Discussion: These results suggest that adding low-dose imipramine to diet counseling with psychological support helps patients losing weight even for at least 6 months off medication. The effect might include a psychological priming of weight loss during the double-blind phase that continues at least for half a year