Objective To investigate the clinical efficacy and safety of repetitive transcranial magnetic stimulation combined with duloxetine in treatment of depression. Methods Sixty-nine cases of depression were randomly divided in?to study group (n=35 patients) and control group (n=34 patients). The study group received duloxetine combined with 1Hz rTMS treatment on the right dorsolateral prefrontal cortex area for 6 weeks whereas the control group received duloxetine combined with pseudo-rTMS treatment for 6 weeks. The Hamilton Depression Rating Scale (HAMD-24) and Treatment Emergent Symptom Scale (TESS) were used to assess the clinical efficacy and the adverse reactions before, 2, 4 and 6 weeks after the treatment, respectively. Results Four patients (two from each group) dropped out of the study. The main effects of time (P<0.001) and groups (P=0.029) were significant and so was the interactive effect of time and group (P<0.001). The clinical curative effect of the study group were significantly better compared with the control group at the 2, 4, 6 weeks following treatment (P<0.001). The adverse reactions were mild in these two groups. Conclusions The combi?nation of 1 Hz rTMS with duloxetine is superior to either medication alone for the treatment depression.