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Depressive disorders in epilepsy often present characteristic clinical manifestations atypical in primary, endogenous depression. Here, we report a case of a 64-year-old woman with right mesial temporal lobe epilepsy, who complained of bizarre, antipsychotic-refractory cenesthetic hallucinations in her interictal phase, and was hospitalized after a suicide attempt. Detailed clinical observations revealed mood symptoms, which led to the diagnosis of interictal dysphoric disorder comorbid with interictal psychosis. Sertraline with low-dose aripiprazole markedly alleviated both depressive and psychotic symptoms. This case suggested that the two diagnostic entities may overlap and that depressive symptoms tend to be concurrent when concurring with psychosis, which hampers the appropriate choice of a treatment option., Highlights • Prominent psychosis overshadowed symptoms of interictal dysphoric disorder (IDD). • Interictal psychosis (IIP) may be more severe form of IDD. • Self-report inventories may miss IDD with psychotic features. • Sertraline with low-dose aripiprazole may be a promising pharmacological treatment in severe IDD.