Abstract: Objective：To compare the efficacy and safety of fluoxetine alone or fluoxetine hydrochloride combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder (MDD) with anxiety symptoms. Methods：One hundred and two inpatients diagnosed as MDD with anxiety symptoms were randomly divided into the combination group (rTMS plus fluoxetine, 51 patients) and the control group (fluoxetine only, 51 patients). The course of treatment was 8 weeks. Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD) and the treatment emergent symptoms scale (TESS) were used to evaluate the efficacy and side effects at baseline, 2, 4 and 8 weeks after treatment.Results：The total effective rate, HAMA and HAMD main effects of time and between groups, and the TESS score of the combined treatment group were better than those of the control group, and the differences were statistically significant (P<0.05). Conclusions：The efficacy and safety of fluoxetine hydrochloride combined with rTMS are better in the treatment of depression with anxiety symptoms than those of fluoxetine alone.