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Background  Undocumented and self-initiated use of psychotropic medications represents a growing public health challenge in primary care. This study aimed to evaluate the prevalence of self-reported occasional use of anxiolytics and/or sedatives among primary healthcare (PHC) patients without a previously registered diagnosis of a mental disorder and without a documented prescription for these medications in their medical charts. Additionally, we investigated the associations of undocumented medication use and sociodemographic parameters with the severity of depressive and anxiety symptoms. Methods  A cross-sectional study was conducted between January 31, 2026, and March 31, 2026, at the Public Health Institution Health Center "Dr. Mustafa Šehović" Tuzla, Bosnia and Herzegovina, enrolling 221 adult PHC patients (N = 221). Depressive and anxiety symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) screening tools. Participants were categorized as users (n = 60) or non-users (n = 161) based on self-reported occasional medication intake. Nonparametric statistical tests (the Mann-Whitney U test and Kruskal-Wallis H test with Bonferroni-adjusted post hoc comparisons) were used for group comparisons. Results  Occasional undocumented use of anxiolytics and/or sedatives was reported by 27.1% (n = 60) of participants. Medication users had significantly higher scores on both the PHQ-9 (median 10.0 (IQR = 7) vs. 4.0 (IQR = 5); p < 0.001) and GAD-7 (median 8.5 (IQR = 9) vs. 4.0 (IQR = 6); p < 0.001) than non-users. Among medication users, a statistically significant association was identified between educational level and depressive symptom severity (H = 6.515, df = 2, p = 0.038); post hoc analysis confirmed that participants with secondary education had significantly higher PHQ-9 scores than those with higher education (p = 0.036). Sex, age, and marital status showed no significant associations with symptom severity within the user group. Conclusion  More than a quarter of primary care patients without a documented mental disorder or prescription for anxiolytics and/or sedatives reported occasional use of these medications and had elevated depressive and anxiety symptom scores. These findings emphasize the clinical need for proactive, comprehensive medication history-taking in family medicine to identify undisclosed psychotropic medication use and underlying psychological distress.