I think a decent cutoff for when to defer to medication is when the problem becomes self-sustaining. E.g. you get anxiety about your anxiety, or your mania lead

I think a decent cutoff for when to defer to medication is when the problem becomes self-sustaining. E.g. you get anxiety about your anxiety, or your mania leads to disastrous actions that can't be emotionally handled in a normal state, or your depression causes you to fail at goals in a way that contributes to your depression. At those points the cycle is the problem and needs to be broken.