Interictal dysphoric disorder is an intermittent and pleiomorphic affective-somatoform disorder that presumably occurs as a result of inhibitory mechanisms in chronic mesial temporal lobe epilepsy. Treatment with antidepressant medication, enhanced if necessary with small doses of an atypical antipsychotic, tends to be highly effective. The dysphoric disorder also occurs in the absence of epilepsy in a subictal variation, particularly in patients with brain lesions and as premenstrual dysphoric disorder. The paroxysmal affects, ranging from irritability through anger to rage, play a major role in interictal dysphoric disorder. Their manifestation among patients with mesial temporal lobe epilepsy is counterbalanced by the fact that these individuals tend to be highly ethical and religious. The paroxysmal affects that may emerge with vehemence during episodes of interictal dysphoric disorder play a role in all people, differing in prominence among individuals. For a comprehensive view of the psychiatric aspects of epilepsy, the important premodern findings are reviewed together with recent ones.