When Patients Take Control: Prevalence, Motivations, and Clinical Correlates of Self-Initiated Psychiatric Medication Changes

Purpose: To examine the prevalence and patterns of mental health patients’ consideration and engagement in self-initiated psychiatric medication discontinuation, identify their motivations, and assess associated factors including fear of discontinuation, trust in psychiatrists, perceived support, and clinical diagnosis. Design: We conducted a multicenter cross-sectional study including 1,574 adult mental health patients from 12 psychiatric clinics and general hospital psychiatric departments across Serbia, Croatia, Bosnia and Herzegovina, and Montenegro. Participants were recruited from inpatient, outpatient, and day-hospital settings. Participants completed a questionnaire on psychiatric medication use, discontinuation experiences, and trust in psychiatrists. Analyses focused on 773 participants who had considered discontinuing medication, examining prevalence, motivations, and related factors. Results: Among 1,574 participants, 773 (49.1%) had considered discontinuation of psychiatric medication; of these, 361 (46.7%) had actually discontinued, with 273 (75.6%) doing so independently—149 (54.6%) abruptly and 122 (44.7%) gradually. Consideration was most frequent in alcohol use (62.4%) and anxiety disorders (59.9%) and the least in organic disorders (25.0%). Overall, 400 (51.7%) participants discussed discontinuation with their psychiatrist; perceived support was highest in alcohol use (65.9%) and anxiety (58.2%) and lowest in psychotic and bipolar disorders (32.0%). Primary motivations were perceived recovery and regaining autonomy. Fear was generally mild to moderate, and trust was high, with trust and motivations not differing meaningfully between independent and psychiatrist-guided discontinuation. Conclusions: Self-initiated medication changes were highly prevalent and occurred amid a pronounced communication gap, with deprescribing discussions largely patient initiated. Motivations were perceived recovery and desire to regain autonomy rather than treatment dissatisfaction. High trust in psychiatrists provides an opportunity to offer individualized deprescribing pathways through proactive shared decision making, reducing the need for patients to discontinue medication independently.