My experience is all of the above. My city has a mental health services and behavioral clinic that does a bit of everything. I see a therapist/social worker, psychiatrist and an MD there. I'll try to explain what I've done so far.

Therapy helped me unpack my history and what's going on currently. Biggest areas for my to work on are Stuck points, Executive function, and Ambiguous loss. This helped me see the correlations with the crippling negative feedback loops.

Psychiatrist prescribed the meds to adjust starting with low doses and gradually working in increasing them. Anti depressant, mood stabilizer, anxiety/blood pressure and a small sleep aid. I haven't really noticed a change, but I have realized recently that I have been a bit easier on myself when it comes to self criticism. Instead of the usual getting in a stuck point due to procrastination (executive function, avoidance coping mechanisms), I've been able to give myself a bit of patience. It's a little strange to link all these things but I suppose the work is working. Been 3 months and I just had one medicine changed due to side effects so we'll see what happens in another 3 months.

MD made me do a bunch of bloodwork. Physical and other issues too. Felt good getting these things in order.

So yeah. Everything still kinda sucks, but I am starting to feel lighter. All of these things combined are helping me to help myself live a better life.