Most of us experience a COVID-19 illness for several days to weeks, miserable with typical cold/flu symptoms, eventually recovering. For a few, recovery does not mean back to normal, but now suffering with a new condition, Long Covid.. Disabling fatigue interferes with work, play, all every day activities. Fatigue following a viral infection is not unusual. Many individuals who have had flu also experience fatigue that interferes with return to usual life activities. For those who suffer Long Covid, finding some way back to normal becomes a difficult trial of seeing doctors and trying to motivate oneself to get off the couch and not nap all day. Conventional medicine doesn’t have adequate answers for Long Covid. Too many are sick and tired of being sick and tired.

A thorough physical exam, laboratory testing, and imaging studies (if indicated) are necessary to rule out a medical condition like anemia, under-active thyroid, diabetes, hypertension, autoimmune disease, and cancer. But Long Covid generally has no lab test abnormalities or findings on a CT scan or MRI.

After being informed that all tests are normal, the doctor diagnoses “depression” and prescribes an anti-depressant medication.

It’s true – one is very depressed being exhausted, without energy to do household chores, work, and forget about intimacy. Sleep is torture, too; taking forever to fall asleep, awakening in the wee hours, unable to return to sleep, eventually sleeping for a few hours and awakening unrefreshed. No wonder there is exhaustion and difficulty in concentration and thinking. Forget about exercise: there is no energy to run or do physical activity. And when the day comes when there is energy to do stuff, hours of physical activity cause a terrible exhaustion the following day with no energy to move.

Strangely, the anti-depressant actually may do a bit of good. Anti-depressants do modify the neurotransmitters and modify our sleep patterns; falling asleep and staying asleep improve. The anti-depressant is not addictive and offers some immediate palliative relief. Additionally, it tends to control anxiety episodes, enhances concentration to some degree, and impressively, makes one less tired and fatigued.

Of course, an anti-depressant reacts differently on each of us; for some it will be a wonderful salve, for others there will be side effects like dry mouth, constipation, dull emotions, and just the aversion to using a pharmaceutical. Herbals offer anti-depressant effects without the use of drugs but herbs do not have the effectiveness of a drug.

The anti-depressant is a good start but it does not address Long Covid adequately. For those who stay exhausted after being treated for depression what else can be done?

The adrenals, the small organs lying above the kidneys, produce adrenaline and cortisol in addition to other hormones. Much has been written about the adverse effect of excess cortisol produced when we are stressed. Cortisol’s excess has been blamed for causing our sleep difficulties and contributing to diseases of overwork: heart disease, diabetes, hypertension, and obesity. But the adrenal’s production of cortisol can also be inadequate or dysfunctional. Measuring cortisol levels several times during the day and night can reveal cortisol levels being low in the morning and afternoon but higher at night which is not normal. Or the cortisol can just be low throughout the day. A lower cortisol level is responsible to a great degree for fatigue and plays an important role in the fatigue following a viral infection like Long Covid. Testing the cortisol level at multiple times during the day is not done following the usual medical consultation but is a good test procedure for the Long COVID patient with fatigue.

Treatment for a low cortisol level is not addressed by prescription medication. Instead, the cortisol dysfunction can be addressed with vitamins, minerals, Omega-3 fatty acids, amino acids, herbals, and homeopathic remedies. Additionally, the use of vitamin and mineral injections, usually administered intravenously, offers dramatic support to the adrenal glands.

Long COVID and chronic fatigue have not been definitely defined and cannot be diagnosed by a simple lab test. However, supportive treatment is available and can begin the restorative process of getting back to normal.

Jonathan Collin, MD practices integrative and conventional medicine in Kirkland, Washington, and Port Townsend, WA. He is the publisher and editor-in-chief of the Townsend e-Letter, the online version of the Townsend Letter, a print magazine which he published from 1983-2023. Dr. Collin has been in medical practice since 1977. He is married to Deborah, has two adult children, and enjoys playing with his grandchildren.