To systematically evaluate the clinical efficacy of acupuncture combined with repetitive transcranial magnetic stimulation (rTMS) in treatment of post-stroke depression. Methods: A systematic search was conducted in databases of CNKI, CBM, Wanfang, VIP, PubMed, Web of Science, Cochrane Library and EMBASE for randomized controlled trials (RCTs) of acupuncture combined with rTMS in the treatment of post-stroke depression from their inception to July 2023. The Cochrane risk of bias assessment tool was used to assess the risk of bias and the quality of the included literature. RevMan 5.4 software was used for meta-analysis, and GRADE software was used to evaluate the quality of evidence for the outcome indicators. Results: Ten studies involving 622 participants were included. The meta-analysis results showed that acupuncture combined with rTMS significantly improved clinical efficacy in patients with post-stroke depression [RR=1.14, 95% CI (1.06, 1.24), P=0.0009]. Moreover, the Hamilton Depression Scale (HAMD) score [MD=－ 3.75, 95% CI (－ 5.86, － 1.64), P=0.0005] and Pittsburgh Sleep Quality Index (PSQI) score showed significant improvement compared to the control group. The quality of evidence was rated as moderate for clinical efficacy, low for HAMD score, and very low for PSQI score. Conclusion: Acupuncture combined with rTMS demonstrates significant benefits in improving depression in patients after stroke.