Objective: To study the clinical effect of fluvoxamine maleate combined with antihypertensive treatment for essential hypertension (EH) combined with anxiety and depression. Methods: Eighty-two patients with EH combined with anxiety and depression were selected as experimental subjects in our hospital, and the cases were collected from January 2021 to January 2025, and all the included subjects were divided into 41 cases in the control group (using antihypertensive treatment combined with conventional psychological counseling interventions) and 41 cases in the experimental group (using fluvoxamine maleate combined with antihypertensive treatment) according to the method of randomized numerical table. The two groups were compared in terms of therapeutic effect, blood pressure level, serum 5-hydroxytryptamine (5-HT) and neurotrophic factor (BDNF) level, Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD), and adverse reactions. Results: The total effective rate of the experimental group was 97.56% (40/41) higher than that of the control group, 78.05% (32/41) (P < 0.05); systolic blood pressure and diastolic blood pressure were lower in the experimental group compared with that of the control group after the treatment (P < 0.05); serum levels of 5-HT and BDNF were higher in the experimental group compared with that of the control group after the treatment (P < 0.05); the HAMA score and HAMD score were lower (P < 0.05); there was no significant difference between 6 cases (14.63%) of adverse reactions in the experimental group compared with 4 cases (9.76%) in the control group (P > 0.05). Conclusion: Fluvoxamine maleate combined with antihypertensive treatment for EH combined with anxiety and depression is effective in reducing patients" blood pressure, regulating 5-HT and BDNF levels, and improving anxiety and depression without increasing the risk of adverse effects.