I finally admitted that it was time to start back on antidepressants, and also discovered propranolol (anti-anxiety med); it's changed my life in the most dramatic ways I can imagine.
As of today I weigh 319 lbs -- from a peak of over 400 -- and just a hair over half way to my goal of being at 240 lbs. This is the biggest change I've ever made in my life, and I couldn't be prouder to have come this far.