Question explored with the scientific record
Conversation so far
- 1 A large portion of Long COVID looks exactly like ME/CFS.When Long COVID includes: Persistent profound fatigue Clear post-exertional malaise (crashes after activity) Unrefreshing sleep Cognitive problems (“brain fog”) Often orthostatic intolerance …it meets the diagnostic criteria for ME/CFS. Many researchers and clinicians now treat this subgroup of Long COVID as post-infectious ME/CFS triggered by SARS-CoV-2.The core features, the fluctuating nature, the lack of a cure, and the management approach (pacing to avoid PEM) are the same. COVID simply produced a large new cohort of people with this pattern of illness. So it is a lifetime illnes with no cure. I thought covid was not + a private exchange
- 2 is long covid a lfetime illness or can one return to a previous activity level after a time period + a private exchange
- 3 just talk long covid. what are the chances of returning to nore mal. + a private exchange
- 4 forget ME?CFS juts talk covid + a private exchange
- 5 what about not hospitalized and full functioning yet sick + a private exchange
- 6 What percentage of non-hospitalized people are still symptomatic at 12+ months? + a private exchange
- 7 thre is NO info on people with long covid after a year? Really?
- 8 Morning cortisol and ACTH for hypocortisolism (See an Endo 20 % of patients show low-normal cortisol; hydrocortisone micro-dosing under specialist care has improved fatigue scores. Low-dose naltrexone (LDN) for neuroinflammation for long covid
Answered on this page ↓
Morning cortisol and ACTH for hypocortisolism (See an Endo 20 % of patients show low-normal cortisol; hydrocortisone micro-dosing under specialist care has improved fatigue scores. Low-dose naltrexone (LDN) for neuroinflammation for long covid
The short version: the cortisol/ACTH and hydrocortisone part is not in this evidence at all. The LDN part is thin and uncontrolled.
Nothing in these records tests morning cortisol, ACTH, or hydrocortisone micro-dosing in long COVID. The "20% low-normal cortisol" figure and the fatigue improvement from micro-dosing are not here, so I cannot confirm or deny them. That is a gap in what I have, not a finding. What would settle it: a randomized trial measuring morning cortisol and ACTH in long COVID patients, then comparing hydrocortisone to placebo on fatigue. I have not seen that trial in this evidence.
For LDN, the only record is an open-label study of 38 long COVID patients on 1 to 3 mg daily for 2 to 3 months, reporting reduced pain, mood symptoms, chest tightness, and cough [1]. No placebo. Self-reported outcomes. That design cannot separate the drug from time, attention, or regression to the mean. A review of immunotherapies for long COVID and POTS found case reports suggesting benefit but controlled trials showing no clear benefit [1]. That is the honest state: plausible mechanism, no controlled proof.
| Intervention | Best evidence here | Design | Verdict |
|---|---|---|---|
| Morning cortisol/ACTH | none in this evidence | - | not answered |
| Hydrocortisone micro-dose | none in this evidence | - | not answered |
| LDN 1-3 mg | 38 patients, symptoms improved [1] | open-label, no placebo | unproven |
My call: LDN is a reasonable thing to try under supervision if you accept it is unproven, and the cortisol/hydrocortisone question needs a real trial that this evidence does not contain. Confidence: low.
Sources used 1
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Immunotherapies for postural orthostatic tachycardia syndrome, other common autonomic disorders, and Long COVID: current state and future direction
Narrative review finds case reports and small studies suggest immunotherapies may benefit some POTS, autonomic disorder, and Long COVID patients, but controlled trials show no clear benefit and larger trials are needed.
DOI: 10.3389/fcimb.2025.1647203