Why Ivermectin Is Part of My Chronic Fatigue Toolkit

You've almost certainly been exposed to Epstein-Barr virus. About 95% of adults have been.

Most of the time, it sits there dormant. You got mono as a teenager, your immune system dealt with it, and the virus went to sleep in your B cells. End of story.

But for some people, the virus wakes back up. Not enough to put you back in bed with full-blown mono. Just enough that your immune system is fighting a low-grade battle 24/7. You're exhausted. Brain fog. Can't recover from exercise the way you used to. You sleep ten hours and wake up feeling like you slept two.

Your doctor ran a CBC and maybe a TSH. Everything's "normal." They suggested you might be depressed. Offered an SSRI. But you're not depressed. You're sick. And nobody has bothered to check for chronic viral reactivation.

This pattern — dormant virus reactivated by stress, illness, or immune disruption — is one of the most common causes of chronic fatigue I see in my Central Texas practice. And it's treatable. One of the tools I reach for in these cases? Ivermectin.

Starting With What's Most Common

When someone comes to me with this kind of fatigue, I don't start by running every test in the book. We try not to hammer patients with a thousand dollars in labs on day one. I have a system, and it starts with the foundations.

First thing is metabolic markers and an expanded thyroid panel. Fasting insulin, fasting glucose, HbA1c, lipids — and then free T3, free T4, total T3, total T4, and TSH. Not just TSH. If the baseline doesn't explain the symptoms, then we go deeper. That's when I start looking at inflammatory markers — high-sensitivity CRP, ESR. Reverse T3. Thyroid antibodies. And for fatigue specifically, this is where I start thinking about viral reactivation.

The Virus Nobody Checks For

About 95% of adults have been exposed to Epstein-Barr virus — it's the virus that causes mono. Most people get exposed as kids or teenagers, their immune system handles it, and life goes on. The virus goes dormant — it hides in your B cells — and for most people, that's the end of the story.

But here's what happens in some patients. Something comes along and overwhelms the immune system. Could be a major stress event, a bad illness, surgery, poor sleep for months on end, gut dysfunction. And that dormant virus wakes back up. Not enough to put you in bed with a full-blown mono relapse — but enough that your immune system is now fighting a low-grade battle 24/7.

That's exhausting. Literally. Your body is spending energy fighting a virus you don't even know is active. You're not sick enough for anyone to take seriously, but you're never actually well.

When I suspect viral reactivation, I run comprehensive viral testing — looking at specific patterns that tell me whether this is old exposure or something that's actively causing problems. I find it a lot. Probably more often than most doctors would expect, because most doctors aren't looking.

Why Ivermectin Is Part of the Approach

So when labs confirm chronic viral reactivation — EBV or sometimes other herpesviruses — one of the tools I use might surprise you. It's ivermectin.

I know. That word got politically radioactive during COVID. A lot of good physicians won't touch it now — not because the science changed, but because the narrative did. I'm not interested in political arguments about medication. I'm interested in what helps my patients get their lives back.

Here's the mechanism, and it's actually elegant. Everyone thinks of ivermectin as an anti-parasitic drug — and it is, and it won a Nobel Prize for that. But the antiviral mechanism is completely separate.

Ivermectin blocks a protein transport pathway called importin alpha/beta. This is the shuttle system that viruses hijack to move their proteins into your cell nucleus. Without nuclear access, the virus can't replicate efficiently. So basically, instead of trying to kill the virus directly, you're cutting off its supply line. The virus is still there, but it can't do its damage.

This has been demonstrated in peer-reviewed research against multiple virus families — HIV, dengue, adenovirus, and yes, herpesviruses including EBV. The importin alpha/beta mechanism was characterized at Monash University. The safety profile spans four decades and billions of doses worldwide. None of that went away because of a news cycle.

The other reason I use it is practical. Ivermectin is cheap. It's well-tolerated. It has a 40-year track record. I can start a patient on an individualized protocol and reassess within a few weeks. If it's going to help, you'll usually know within that window.

Layering the Approach

Ivermectin alone isn't always enough. For some patients it is — they start feeling noticeably better within a few weeks and we build from there. But for the more stubborn cases, I layer in additional tools based on what we're seeing in labs and how they're responding.

There are other immune-modulating medications that work beautifully alongside antiviral support. The combination can be a game-changer for patients dealing with chronic fatigue from viral reactivation.

But here's what I always tell patients: you can throw all the targeted treatment you want at someone, but if the foundations are a mess, nothing's going to stick. If your gut is wrecked, you're sleeping five hours a night, and your diet is driving inflammation — we have to address that too. That's Tier 1 work. Gut health, metabolic health, stress response. Those are the pillars everything else rests on.

Sometimes patients come to me so depleted that telling them to overhaul their diet feels almost cruel. They can barely get through the day. So we intervene medically first — address the viral component, get their energy up enough that they can actually make changes — and then we tackle the foundations. You have to meet people where they are.

The Long COVID Connection

This same framework applies directly to Long COVID. I'm seeing patients two and three years out from their initial infection still dealing with brain fog, fatigue, and exercise intolerance that nobody can explain. The standard approach has essentially been "wait it out." That's not good enough.

What the research shows: many Long COVID cases involve persistent viral reservoirs AND reactivation of latent viruses like EBV and HHV-6. The initial infection overwhelms the immune system, and dormant viruses take advantage of the gap. So now you've got the direct damage from the original infection layered on top of chronic viral reactivation.

When you address the viral component with targeted protocols, support the immune system properly, clean up the gut, and address metabolic health — most patients start turning the corner. Not everyone. I'm not going to tell you it's a magic bullet. Some cases are genuinely complex and need months of layered treatment. But the response rate I see with this approach is significantly better than "take an antidepressant and wait."

What People Get Wrong About This

The biggest misconception is that any of this is political. It's not. These are medications with specific mechanisms that address specific problems. I use them the same way I use any other tool — because the clinical situation calls for it.

The second misconception is that chronic fatigue is somehow mysterious or untreatable. It's not. It's one of the most solvable problems I deal with. The issue isn't that answers don't exist — it's that nobody's looking in the right places. When your doctor runs a CBC and a TSH and calls it a day, they've barely scratched the surface.

My approach: start with baseline metabolic and thyroid labs. If those don't explain the picture, look for viral reactivation and inflammation. Address whatever we find with individualized treatment protocols based on testing. Keep digging until we have answers. That's what functional medicine is supposed to do.

What This Looks Like in Practice

A version of this walks into my office every week. Exhausted for months. Labs keep coming back "normal." Other doctors have offered antidepressants without investigating.

We run comprehensive testing. We typically find chronic viral reactivation along with metabolic dysfunction — often insulin resistance that nobody's checked for. We start targeted antiviral treatment. Within a few weeks, energy starts coming back. Not cured — we still have work to do — but functional again. That's the part that matters.

They're sleeping better. Brain fog is lifting. They can exercise again without crashing the next day. We're still addressing gut health, optimizing thyroid, working on sleep quality. But they have their energy back enough to start living again.

If you've been tired for months. If you've been told your labs are normal. If you've been offered an antidepressant when what you needed was someone to actually investigate — that's exactly what we do at Rooted Health Clinic.

Give us a call at 254-780-0023 or visit rootedhealthclinic.com.

Rooted Health Clinic — Salado, TX