Objective To explore the clinical efficacy of low frequency repetitive transcranial magnetic stimulation （LF-rTMS） （1 Hz） combined with escitalopram for sleep disorders in adolescents with depressive. Methods A total of 82 sleep disorders in adolescents with depressive disorder who attended the Department of Comprehensive Psychology of the Kashgar First People's Hospital from January 2023 to January 2024 were retrospectively selected for the study. The study subjects were divided into control group （40 cases， escitalopram） and study group （42 cases， LF-rTMS in combination with escitalopram） according to the treatment method. Clinical efficacy， Hamilton Anxiety Scale （HAMA） scores， Hamilton Depression Scale-17 （HAMD-17） scores， Pittsburgh Sleep Quality Index （PSQI） scores， quality of sleep， polysomnographic indices， quality of life， serum indices， and the incidence of adverse reactions were compared between the two groups. Results The treatment efficiency of study group was higher than that of control group ［90.48% （38/42） vs. 72.50% （29/40）］， and the difference was statistically significant （χ2 =4.430， P ＜ 0.05）. The pre- and post-treatment differences of HAMA， HAMD and PSQI scores in study group were significantly higher than those in control group ［（7.16±1.28） vs. （6.38±1.05）， （12.86±1.60） vs. （8.64±2.35）， （6.63±1.05） vs. （4.97±0.43） scores］， and the differences were all statistically significant （t=3.009， 9.546， 9.283； all P ＜ 0.01）. The pre-and post-treatment differences in total sleep time （TST）， sleep latency （SL）， number of awakenings （NW）， and awakening time （AT） in study group were higher than those in control group ［（3.01±0.76） h vs. （1.12±0.69） h， （27.34±7.75） min vs. （23.06±1.24） min， （1.68±0.38） times vs. （1.02±0.15） times， （67.53±4.71） min vs. （62.57±4.12） min］， and the differences were statistically significant （t=11.772， 3.450，10.248， 5.065； all P ＜ 0.001）. The pre- and post-treatment differences in the physical， social， emotional， and somatic scores of quality of life in study group were higher than those in control group ［（13.40±3.55） vs. （9.01±1.68）， （20.38±1.01） vs. （12.76±0.73）， （10.93±1.89） vs. （7.12±0.79）， （7.45±2.13） vs. （4.12±1.76） scores］， and the differences were statistically significant （t=7.099， 38.990， 11.834， 7.697； all P ＜ 0.001）. The pre- and post-treatment differences in gamma-aminobutyric acid （GABA），5-hydroxytryptamine （5-HT）， and brain-derived neurotrophic factor （BDNF） in study group was higher than that in control group ［（2.84±0.27） ng/ml vs. （2.31±0.25） ng/ml， （56.44±9.83） ng/ml vs. （36.02±8.35） ng/ml， （6.51±0.24） ng/ml vs. （5.63±0.32） ng/ml］， and the differences were statistically significant （t=9.211， 10.114，14.132； all P ＜ 0.001）. The difference in the incidence of adverse reactions between the two groups was not statistically significant （P ＞ 0.05）. Conclusions Combined treatment with LF-rTMS and Escitalopram for depressive adolescents with sleep disorders can improve their depressive symptoms and sleep quality， enhance the patients' quality of life， and improve relevant serum indexes， which has good clinical application value.