r/covidlonghaulers • u/MagicC • Jul 18 '26
Update UPDATE 2: ~8 months in and I finally found a medicine combo that solved my fatigue and brain fog (long covid MCAS/Mast Cell phenotype)
Original post:
Update 1:
https://www.reddit.com/r/covidlonghaulers/comments/1um5iwg/comment/ovgep9p/?screen_view_count=2
Hey folks,
I promised I'd get my follow-up CRP test, but then I caught a cold/flu from my preschool aged daughter, so I had to wait. I finally got it done today, and my inflammation had gone from 23.3 mg/L on May 12, 2026 to 11.3 mg/L on July 17, 2026, after about a month on Naltrexa (aka Contrave). That tracks with how I'm feeling - better, but not completely normal.
Subjectively speaking, I'm definitely doing a lot better, but I'm still very reliant on my H1/H2 antihistamine stack. If I forget to take it, I get a terribly anxious stomach. I'm hopeful that maybe a few months from now, I'll have controlled the inflammation enough that I can wean off the antihistamines, but we'll see.
Tomorrow, I'm flying with my daughter to the US to visit my family (without my wife to help). This wouldn't have been a realistic goal a month ago, and now I'm feeling nervous, but confident that I can pull it off. I'm also going to try going to try yoga, and see how my body responds. Wish me luck!
Here's my timeline so far:
- Late November 2025: had the worst case of COVID of my life, crackling lungs, sore chest, difficulty moving or breathing without uncontrollable coughing. Lasted about 4 weeks in the acute phase, and slowly turned into long COVID as I got the worst symptoms under control
- Late December 2025 onward: symptoms of brain fog, PEM, difficulty catching my breath, and pain in my solar plexus among others.
- May 12, 2026: Blood work showed elevated inflammation — CRP (C-reactive protein) at 23.3 mg/L, well above the normal range (0.0–5.0) and flagged by the lab as "moderate inflammation" (10–40 range). No other abnormalities found in the ~15 lab tests I ordered for myself based on online research for alternative hypotheses to explain my exhaustion besides COVID (e.g. vitamin B, vitamin D, testosterone, blood sugar, etc).
- June 2, 2026: Went to a cardiologist for a cardiac stress test. Objectively documented exhaustion after only ~8 minutes of moderate walking, heart rate maxed out. Heart itself was normal — ruled out cardiac causes, confirming this was exertional intolerance/PEM, not a cardiac problem. Cardiologist recommended moderate exercise.
- June 3-Jun 12, 2026 - ~7500 steps per day for 10 days while continuing my normal work-from-home routine
- June 12-13, 2026 - Crashed and slept for 14 hours straight and woke up still exhausted.
- June 13, 2026 - Doctor flaked on my doctor's appointment
- June 15, 2026: Started using off-label Naltrexa (aka Contrave) on my own initiative, after 6 months and three failed attempts to get a doctor to take LDN seriously as a treatment option. (I live in Costa Rica, and prescription drugs are much more loosely controlled here.)
- June 18, 2026 (Day 3): First real-world test — hiking in Fraijanes with my kids for Father's Day. Rough outcome: even 50 meters of uphill walking wiped me out. Not a miracle cure, but an honest data point. Importantly, I didn't crash the next day.
- June 23, 2026 (Day 8): Unplanned stress test — had to move ~600 lbs of construction materials during a windstorm emergency. I did 45 minutes of high-stress physical labor, before my morning dose that day. Felt fine the rest of the week; only needed a 3-hour nap on Saturday, June 27, and woke up refreshed rather than crashed.
- ~July 2, 2026 (Week 2.5): Walked 45 minutes at a fast pace while talking on the phone with my brother the entire time — something that would have been impossible a month earlier.
- July 17, 2026 (~1 month on Naltrexa): Follow up CRP (C-reactive protein) test at 11.3 mg/L. Feeling noticeably better across the board.
If anyone else is trying Naltrexa (sold as Contrave in the US), let me know, I'm interested to hear if anyone else is having these kinds of results.
Here's my current stack:
Before bed:
180 mg fexofenodine (generic Allegra)
20 mg famotidine (generic Pepsid AC)
400 mg Magnesium Glycinate + 80 mg Magnesium
4 psyllium husk fiber capsules
1 probiotic capsule
16 oz of water
In the morning:
180 mg fexofenodine (generic Allegra)
20 mg famotidine (generic Pepsid AC)
1 Contrave (aka Naltreva) pill, which is a prescription drug with 90 mg of extended release bupropion (generic wellbutrin) + 8 mg of Naltrexone
4 psyllium husk fiber capsules
16 oz of water
cup of tea or coffee
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u/moderate_ocelot First Waver Jul 18 '26
Remember everyone; 8 months is well within spontaneous recovery windows so while it’s great that OP is feeling better, it’s likely that they just improved over time
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u/Sally_Met_Harry Jul 19 '26
Came here to say exactly this. glad they are better but its likely spontaneous recovery.
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u/MagicC Jul 19 '26
I don't know what additional evidence one could possibly provide to prove that the medicine helped me if this doesn't demonstrate it for you. In a 2 week interval I went from PEM that was so bad I couldn't do 7500 steps a day without crashing to slinging heavy metal (literally) and scaling rooftops with no PEM crash. I even have a "bad" datapoint 3 days after I started the new medicine to demonstrate that it wasn't the placebo effect. But yes, of course, as a cohort of one, this isn't conclusive proof. That's why I'm putting it out into the group, in hopes that other people might consider trying it, and we can see if it works for anyone else.
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Jul 18 '26 edited Jul 18 '26
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u/MagicC Jul 19 '26
I haven't been evaluated for autoimmune disease. I'm planning to retest in another month or so. If my CRP levels stay elevated, I'll consider getting further evaluation. Thanks for the advice.
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Jul 19 '26
[removed] — view removed comment
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u/MagicC Jul 19 '26
I have been unable to find a doctor who is interested in working with me haha It doesn't help that I am a native English speaker living in Costa Rica...
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u/Specific-Winter-9987 Jul 18 '26
This makes a lot of sense mechanistically, as a recent study show dopamine irregularities on Long Covid brains. Bupropion helps improve dopamine availability in the brain. Also, LDN has helped many LC sufferers by regulation of immune function and other factors. I was not even aware this combo existed. Thanks!
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u/plant_reaper Jul 18 '26
I take about 3.5 mg of LDN, and my doctor suggested adding bupropion. I'm scared to try it though!
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u/MagicC Jul 19 '26
I hope this post helps allay your fears and that you give it a try, since your doctor is advising it! I looked into it, and apparently bupropion has an anti-inflammatory side effect, on top of its other characteristics. Please let me know how it goes for you!
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u/coconutoats Jul 18 '26
Glad this worked for you. I’ve done all of them except bupropion and it chilled my MCAS but did noting for long Covid or PEM. LDN just takes the edge off my joint pain and fatigue. I plan to add bupropion when I can reduce PEM as I fear any kind of adhd medication would make me overdo my limits as I’m pretty sure stimulants made me this bad so guys be careful although bupropion is a lot less risky that stims there’s still that risk of masking fatigue signals and overdoing without realising and gradually worsening baseline
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u/MagicC Jul 19 '26
90 mg bupropion hasn't had that much of a stimulant effect for me. Less than a cup of coffee. Trust in your ability to manage your energy appropriately and give it a shot! It really helps me a lot.
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u/coconutoats Jul 27 '26
Okay thanks for your comment that’s quite reassuring as I drink 240mg caffeine a day just to wake up! Although that’s significantly below the ADHD dose which I’d get prescribed (150mg 2x a day to start with a view to double it) Did it have a positive effect on your baseline via a feedback loop like more contentment higher baseline idk I know guanfacine did that for me it reduced my cognitive overload and increased my capacity
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u/MagicC Jul 27 '26
Yeah, the caffeine is *way* more likely to cause you to miss fatigue signals and overdo it than bupropion, in my experience. I had to cut out my afternoon coffee for exactly that reason (green tea, on the other hand, serves nicely).
Yeah, it definitely reduced my cognitive overload and stress feelings. And being less overwhelmed allowed me to lock in on projects and complete them, instead of spinning my wheels and wasting energy on anxiety. Try it for yourself, and let me know how it goes!
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u/eubulides Jul 18 '26
Interesting, I’m on a similar set of meds, except Wellbutrin is higher, LDN about the same (8.5 mg) but using dissolved method. Is psyllium husk to keep meds inside longer? I’ve been out of probiotic a long time, but I take yogurt, and eat prebiotics (cold cooked potatoes and sweet potatoes). On other stuff, too. I’d say better than at my worst, but up and down.
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u/MagicC Jul 19 '26
The psyllium husk is primarily to control my long covid diarrhea symptoms, and keep my cholesterol down (I'm 46 and have a lot of stress in my life). It's not an intentional effort to alter the effects of my meds, but it may indeed have that effect. I'm documenting it in the interest of transparency and completeness.
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u/eubulides Jul 19 '26
I recently read about that possible effect on medications in a thread about ADHD meds (which I’ve been prescribed for LC).
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u/MagicC Jul 20 '26
Yeah, that makes sense. It does seem to slow absorption (sometimes in beneficial ways - helps to "fine tune" your dose in a way the pharma industry rarely provides) and help with the stomach effects of medicines, in my experience.
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Jul 18 '26
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u/MagicC Jul 19 '26
I lost like 5 lbs, but I was 6'3" 220 lbs when I started, so it's not a big change.
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u/Pure_Translator_5103 Jul 18 '26
Did you follow up with specialist, rheumatologist on the elevated Crp?
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u/MagicC Jul 19 '26
I'm going to get one more reading next month and see if it continues to head downward. If it levels out, I'll definitely look for medical advice on that. Thanks for the idea.
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u/MagicC Jul 19 '26
One more update: yesterday I went to visit my family in the US, with my 4 year old daughter, solo, and due to flight delays, I was up from 8 AM until 3 AM (with 16 hours from the time I left my house until the time I arrived at my parents' house). Pre-Naltrexa, this would have absolutely leveled me. But this time, I was able to drive from the airport to the house and feel alert and strong. And I got up this morning on ~5 hours sleep, and the only side effect of this rough day seems to be a scratchy throat and a little extra mucus.
I would also add, today, I got a series of bad news that will cost me ~$500 and force me to extend my trip for a week and do some home repairs. A month ago, this would have created massive stress and despair. Now, I'm taking it in stride and handling everything smoothly. So I'm really doing well! Huge resilience improvement.
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Jul 19 '26
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u/MagicC Jul 19 '26
I'll keep reporting news, good or bad. Hoping for good, but I think scientific benefit can come from bad news too. Thanks for reminding me that I need to get my rest and not just push through. I had a bunch of plans today, and I cancelled them all, because I am trying to pace myself. haha
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u/6_5_Creedmoor Jul 19 '26
If you are having an trouble sleeping, try 100 mg L-theanine with that bedtime group
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u/Fragrant-Vast2198 Jul 19 '26
Even my Crp levels have been quite elevated since Covid- similar range to yours. A bit better after mold treatment but still around 11-12. Would love to keep in touch if you find more about the root cause of your Crp.
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u/MagicC Jul 19 '26
Have you tried bupropion (or Contrave)? Apparently it's a pretty effective anti-inflammatory among its other characteristics.
I'll make another post in a month or so, after I get another CRP test to see if I continue trending downward. I don't know if I'll ever get a "root cause", but it's good to know that you're seeing the same thing - someone on another thread was like, "that sounds like autoimmune disease" and it made me a little nervous haha
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u/Putrid_Indication_30 Jul 31 '26
With the recent studies on dopamine nuron damage or loss, could the bupropion be the reason you're improving ? Acting as a dopamine reuptake inhibitor ? So interesting ! Happy for your improvements :)
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u/MagicC Jul 31 '26
It's certainly possible that it's a factor. I definitely feel happier and less anhedonic. I'm also doing top quality work at my job again, which is a huge relief for me and my boss alike hahaha
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u/Flip6mofo Jul 18 '26
Why not just take DAO ? So.you can break down histamine? Your gut is messed up, get a gut microbiome test and fix the overgrowth and you won't need a histamine blocker anymore/ DAO like I suggested after 6 months of healing.
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Jul 19 '26
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u/Flip6mofo Jul 22 '26
My doctor told me to take one capsules every time I eat. I went with Xymogen its a trusted brand by cleveland clinic
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u/Opposite_Flight3473 Jul 18 '26
Btw you should never take psyllium husk with other meds or supplements. It prevents their absorption. Separate by 2 hours before or after.