Suicide Effexor Withdrawal & Steroids 21/12/2004 California Ballplayer Commits Suicide
Summary:
Paragraph 66 reads: "Garibaldi also told Cox he had reduced his dosage of Effexor and intended to stop taking the drug altogether because he wanted to take steroids free of any interactions with other "mind-altering agents" that he was being prescribed, according to Cox's records."
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2004/12/19/MNG14AEB7S1.DTL
Dreams, steroids, death -- a ballplayer's downfall
Mark Fainaru-Wada, Chronicle Staff Writer
Sunday, December 19, 2004
For years, the message had been clear to Rob Garibaldi, a kid with major-league tools but minor-league size: Get bigger. Fast.
Garibaldi heard it from the coach/nutritional supplement salesman who started him on legal weight-gaining substances at age 16.
He heard it from University of Southern California trainers who handed him two shopping bags of supplements on a recruiting visit and told him he needed to put on 20 pounds.
He heard it from pro scouts who said he just didn't quite fit the physical profile they were looking for in big league baseball.
Garibaldi's response was to use steroids, and his parents and his psychiatrist say it was the extensive use of those drugs that led the once- vibrant young man down an increasingly troubled path that ended in a derailed baseball career, depression and months of emotional turmoil before he ultimately committed suicide at the age of 24.
His friends and family say Garibaldi, a former star high school outfielder in Petaluma, was simply following behavior he was seeing everywhere -- from the college ball fields where he competed to professional stadiums where superstars like Barry Bonds and Mark McGwire clouted home runs regularly.
His father, Ray Garibaldi, says he learned of his son's steroid use just months before Rob shot himself. He confronted Rob and demanded to know what drugs he was using. The son erupted, choking his father and yelling:
"I'm on steroids, what do you think? Who do you think I am? I'm a baseball player, baseball players take steroids. How do you think Bonds hits all his home runs? How do you think all these guys do all this stuff? You think they do it from just working out normal?"
His mother, Denise Garibaldi, said she heard the same kinds of explanations.
"In his mind, he felt like all the guys were getting away with this," she said. "Cheating and doing this is part of what's going on every day, and it was required. This was what you had to do to be a ballplayer.
"He said that in order to make it into that caliber, you had to do steroids. And if Barry Bonds is doing it, Mark McGwire was doing it, then skinny little old him for sure had to be doing it."
The Garibaldis said Bonds was one of Rob's idols growing up, and Denise, a clinical psychologist, believed that was a factor. "As far as he was concerned, Bonds gave him permission to use," she said.
As all this was unfolding in the Garibaldi household, federal authorities in the Bay Area were launching an investigation that would ultimately result in indictments involving the distribution of steroids and other performance- enhancing drugs to some of the world's greatest athletes -- and turn public attention to the influence that drug cheating by sports stars might have on the nation's youth.
The Chronicle reported this month on the grand jury testimony of two baseball stars who were among the most prominent clients of BALCO, the Burlingame laboratory at the center of the sports doping scandal.
Bonds, who set baseball's single season home run record with 73 in 2001 and has publicly denied using steroids, told the grand jury that he used a clear substance and a cream provided by a friend who is now accused of distributing BALCO drugs, but that he never thought they were steroids. New York Yankees slugger Jason Giambi testified that he used steroids and also injected human growth hormone.
After The Chronicle reported on the testimony, U.S. Surgeon General Richard Carmona told the Associated Press that the problem of steroid use was "less a moral and ethical issue than it is a public health issue. If youngsters are seeing their role models practicing this kind of behavior and it seems acceptable, then we need to do something about that because it is a health risk."
Psychological impact
In the early morning of Oct. 1, 2002, sitting in a car just around the block from his parents' home, Rob Garibaldi finally put an end to what had been a tumultuous period plagued by depression, rage and delusional behavior, using a .357 Magnum he had stolen the day before.
For a year and a half, the Garibaldis grieved privately, trying to make sense of their son's dramatic downward spiral. Then, in early March of this year, they saw the parents of a Texas high school baseball player named Taylor Hooton describing on national television how their son had hanged himself as a result of steroid use. The Garibaldis found it hauntingly familiar, and soon began to tell Rob's story to high school students, national television audiences and state legislators who had taken up the cause in the wake of the BALCO scandal.
As the Garibaldis now realize, Rob's steroid use dated all the way back to the summer of 1997, when he was 18 years old and had just been honored as a prep All-American at Casa Grande High School. That places him in a population of steroid users for whom parents, lawmakers, coaches and experts are most concerned: teenagers.
An annual study by the University of Michigan indicates that steroid use among all students in eighth through 12th grades rose yearly throughout the 1990s, an indication that many kids recognized the drugs could benefit not only athletes but boys and girls simply seeking the body beautiful.
The most recent Michigan study, from last year, showed a decline in some areas but still reported that 3.5 percent of 12th-graders acknowledged they had used steroids at some point and 2.1 percent admitted to using in the past year. Other studies have indicated use among teens anywhere from 3 to 11 percent.
Steroids enable athletes to work out harder and build up muscle. But in addition to potential physical dangers such as liver damage and heart disease, experts say, steroid use can create psychological trauma.
Dr. Harrison Pope, the director of the biological psychiatry laboratory at McLean Hospital/Harvard Medical School, said in a telephone interview that in addition to the aggressive behavior often linked with steroid use, the withdrawal from using can lead to depression and, in extreme cases, suicide.
Garibaldi's concerns about his body and the use of steroids weren't the only issues he struggled with. Since age 22, he had been taking antidepressants that have since been said to increase suicidal tendencies in children. He also had a learning disability that led him to take Provigil, a drug prescribed to help cope with the effects of Attention Deficit Hyperactivity Disorder. And there were periods of marijuana use and drinking that coincided with his taking some of the drugs, friends and family members say.
He also told his psychiatrist he was adjusting his prescribed medications on his own so as not to decrease the effects of the steroids.
Still, Garibaldi's psychiatrist, Dr. Brent Cox, said a series of rage incidents and other emotional issues coincided precisely with three separate, 10-week periods of steroid use that Garibaldi described during sessions. Similarly, excessive bouts of depression fell in line with periods when he had stopped using the drugs, Cox said.
Ray and Denise Garibaldi said their own extensive research convinced them steroids were the ultimate culprit in Rob's emotional demise.
Garibaldi went from being a young man universally described as outgoing and well adjusted to an entirely foreign figure to his friends and family.
"The behavior seemed to come back pretty reliably when he was using anabolic steroids and disappear when he stopped," said Cox, the psychiatrist, who spoke with the family's permission. "There was really a dramatic transformation in this guy. There was a really edgy, irritable quality when he was using steroids, like he was just ready to jump across the room and throttle you."
The artificial path
Rob Garibaldi's biggest problem was that he was too little. So he ultimately set out to bulk up in a way that all the weight lifting and nutritional supplementation couldn't help.
"This wasn't an adolescent kid who was looking for beach muscle or whatnot," said P.J. Poiani, who was one of Garibaldi's closest high school friends and who said he was with him when he took steroids for the first time. "This was a kid who every hope and dream he had was surrounded by baseball. And you do whatever it takes."
He was never going to be big enough -- not like his father, a bear of a man who said he was a pretty good baseball player before an injury shortened his playing days, or his older brother Ray Jr., now 6-foot-2 and 200 pounds. From the time he was a 5-foot-9, 125-pound sophomore playing on Casa Grande's varsity squad, Rob had been trying to pump up.
It was then that Garibaldi began to lift weights and receive nutritional supplements, first from Rob Bruno, a salesman at a supplement company who coached Garibaldi on a traveling all-star team, and later from Casa Grande assistant coach Paul Maytorena.
When he left high school in 1997, after three years of lifting weights and ingesting an array of weight- and muscle-gaining supplements that included some legal but controversial substances, Rob was 5-foot-11, 150 pounds -- bigger, but not nearly big enough, he felt.
The supplements he took, his father said, included creatine and androstenedione, known as Andro, the steroid precursor Mark McGwire admitted to using when he hit 70 home runs in 1998. Creatine had become a popular supplement among athletes and gym rats, although there were warnings about its potential dangers, including possible cancer risks.
"What I say now and what I hope I said then is that you need to get stronger, not bigger," said Maytorena, who said he has a degree in exercise science from Sonoma State. Maytorena said he monitored Garibaldi's use of the supplements and provided his parents with information about the substances.
Bruno, who said he was a power-lifter for years, said he gave Garibaldi only a basic weight-gaining supplement distributed by his company and not creatine, but Ray Garibaldi said his son did receive creatine from the coach.
"Obviously, we're going to tell a kid what they need to do in regard to getting bigger and stronger," said Bruno. He said he told Garibaldi what he told many other youngsters, to use supplements as a complement to a solid weight-training program because, "If you're going to be a great athlete, you need to be strong."
Garibaldi later would tell his parents that taking steroids was essentially an extension of taking these supplements.
In the summer after Garibaldi's high school graduation, in preparation for beginning school and a baseball career at the College of San Mateo, Garibaldi decided he needed some artificial assistance with his weight- training program.
"He called me up one day and said he wanted to get bigger, wanted to get stronger," said Brian Seibel, one of Garibaldi's closest friends. "He thought steroids were the way to do it."
Garibaldi had heard Mexico was an easy place to buy steroids -- which are illegal to buy or use without a doctor's prescription -- so he and Seibel told their respective parents they were going camping, hopped in Garibaldi's car and headed south. They stopped in San Diego, slept in the car overnight, then drove into Tijuana the next morning.
Seibel thinks Garibaldi knew going in that he wanted to get Sustanon, a substance the Web site steroid.com describes as a "very popular steroid" that is a "mixture of four different testosterones which, based on the well-timed composition, have a synergistic effect." The teenagers walked into the first pharmacy they came upon, and Garibaldi was directed to a doctor's office around the corner. There, he gave the doctor some cash, Seibel said, then returned with a prescription.
Garibaldi hid the steroids behind a car stereo speaker as he and Seibel drove back across the border.
"We were in Mexico I would say probably even less than an hour," recalled Seibel, who said he only went along for the trip and never had any interest in using steroids.
The whole transaction cost about $250-$300.
Athletes typically take steroids for a period of weeks, called a cycle; upon returning home, Garibaldi began his first cycle. The stuff from Mexico, Poiani said, had everything he needed -- syringes, needles and steroids -- and so, with Poiani watching, Garibaldi injected himself in the buttocks for the first of what would be many times.
"I mean, Rob always talked about how he was scared of needles in terms of the doctor, so it was kind of comical in some ways," Poiani said. "He was kind of laughing about just how scared he was, but he just did it. And then it got easier."
Garibaldi completed an eight-week cycle that summer, according to Poiani, and the results showed. Poiani thought his pal gained eight to 10 pounds.
Garibaldi eventually abandoned his plan to attend and play ball at San Mateo. Instead, he lived at home most of that first year out of high school and helped his old high school coach, Bob Leslie, who had mouth cancer and would die that June.
At that same time, Poiani said, Garibaldi was working out a lot -- and taking another cycle of Sustanon.
"He took a long cycle," Poiani said. "Because I remember at the time being a friend thinking, 'What the hell are you doing?' I think people usually take six- to 10-week cycles. I think he was into something like 14 weeks or something crazy."
Cycles are designed to optimize the effectiveness of the drugs and minimize side effects, with users being "on" for a number of weeks and then "off" for a similar period of time.
"He blew up at that point, I mean for his standards," Poiani said.
One year later, after enrolling at Santa Rosa Junior College in the fall of 1998, the now-5-foot-11, 165-pound Garibaldi put together one of the most prolific seasons in school history. He hit .459 with 14 home runs and 77 runs batted in, earning him state Community College Player of the Year honors.
The performance was good enough to earn him a scholarship to USC, which had one of the nation's top Division I baseball programs. It was also good enough to get Garibaldi selected by the New York Yankees during the June 1999 major league draft, though not until the 41st round.
"They have their body types and all that," Garibaldi told the Press Democrat of Santa Rosa. "I'm not quite big enough."
Garibaldi chose the scholarship to USC, the top college choice of his parents, who were particularly comforted by the school's strong program to help kids with learning disabilities. During a recruiting visit to USC in October, while Ray and Denise met with an academic counselor, Rob took a tour of the training facilities.
He emerged loaded down with containers of supplements, including creatine.
"They said I have to put on 20 pounds," Rob, who had just turned 22, told his parents.
Garibaldi started at USC in January 2000, and he immediately had an impact. He hit .329 with eight home runs and 44 runs batted in to help the Trojans reach the College World Series. Baseball America placed him among the top 100 college players going into the 2001 season. "When they went to the World Series, he said, 'All of my dreams have come true,' " his mother recalled. "Being on that field meant everything to him. It was right after that that it all went askew."
Losing control at USC
First came news that Garibaldi was having academic troubles.
So rather than spend the summer playing ball in the Cape Cod League, as planned, he returned home and took classes to ensure he would be eligible the next season. He became depressed, mostly because of the academic struggles, girlfriend troubles and the transition from the high of the College World Series to the low of not even being able to play ball at all. His mom suggested he see Cox, a psychiatrist colleague of hers.
Cox ultimately prescribed the antidepressant Effexor, and the drug seemed to work well. Not long before returning to USC, Garibaldi told Cox his time back home represented "the best summer I ever had," according to the psychiatrist's records. Cox knew nothing about his steroid use.
In September, Garibaldi began a 10-week cycle of Deca Durabolin, which steroid.com describes as "the most widespread and most commonly used injectable steroid." His parents visited USC one month later, and Denise said Rob pulled her aside at one point to show her how he had taken a baseball bat to his dresser.
Garibaldi told his mom he was in trouble: He had failed a midterm, was sleeping excessively and wasn't really sure the antidepressants were helping at all.
Pope, the Harvard psychiatrist with expertise in steroid use, said various studies have supported the notion of " 'roid rage" -- with users exhibiting irritability, aggressiveness and sometimes violence, along with a disregard for the consequences.
Pope also cited problems associated with steroid withdrawal, particularly when a person abruptly stops using rather than cycles off the drugs by lowering the dosage in the final weeks. Among the symptoms are depression, disinterest, excessive sleeping, loss of appetite, and, in extreme cases, suicidal behavior.
A week after Garibaldi showed his mom the battered dresser, the Garibaldis received a call from USC's head baseball coach, Mike Gillespie. Rob had slept through practice.
None of this made sense to Ray and Denise. Their once confident, outgoing, successful and responsible kid was now falling apart. Garibaldi later told friends and family that he was getting teased a lot at USC both about his size and his learning disability. He told his family and friends that Gillespie called him stupid.
Garibaldi made his first admission to Cox about his use of steroids during a phone session the following May, when he said he was in the midst of a 10-week cycle of Deca.
Garibaldi also told Cox he had reduced his dosage of Effexor and intended to stop taking the drug altogether because he wanted to take steroids free of any interactions with other "mind-altering agents" that he was being prescribed, according to Cox's records.
Cox said he advised Garibaldi to stop using steroids, but Garibaldi said that he wanted to gain 10 to 15 pounds. He said he was getting the Deca from a source who was providing the same drug to several Oakland A's players. The A's declined comment.
"The irony is, he is telling me all this with the mind-set of a warrior," Cox said. "He was like a warrior going into battle, and he had to go through this sacrifice in order to sculpt his body into the perfect specimen."
Apparently nobody but Cox -- who as Garibaldi's psychiatrist couldn't tell anyone -- knew about the steroid use.
Things continued to deteriorate in the spring of 2001. There were repeated clashes with Gillespie, and Rob's behavior became increasingly erratic. His parents say they later were told by one of Rob's roommates that the other players who were living with him had begun locking their doors out of fear.
Finally, just weeks before USC was set to make another College World Series appearance in June 2001, Gillespie kicked Garibaldi off the team and took away his scholarship.
Garibaldi's allegations about his life at USC and treatment by his coach and teammates are not news to officials there.
"The best response from us would be that all these allegations that we've heard before, we've maintained are not true, and we have even maintained that we are prepared to file a defamation suit," said a USC spokesman.
The final act
Maytorena, Garibaldi's coach and friend since his Casa Grande days, said the young man told him about his steroid use sometime after returning from USC. Maytorena, now head baseball coach at Casa Grande, said he believed Rob was using both Deca and Sustanon at the same time, and he urged him to quit the drugs.
In the fall of 2001, Maytorena helped Garibaldi get lined up with his alma mater, Sonoma State, where he had played for coach John Goelz. Garibaldi seemed to start off relatively well, but his mental well-being quickly deteriorated -- to the point that Goelz was having to write practice times on Garibaldi's wrist to make sure the outfielder wasn't late. Denise Garibaldi said she had to become her son's ultra-guardian.
"For the whole semester, I became his superego," she said. "I told him where he had to be at what time. I would write everything down for him. I put Post-Its in his car. I would talk to the teachers myself about what the assignments were."
How much or how often Garibaldi used steroids at Sonoma State is unclear. He would later tell his parents he took just one cycle during this time, beginning in the late spring of 2002. Maytorena said he believed Garibaldi did at least two cycles during his time at Sonoma State.
"He would back up cycles," Maytorena said. "You know, it got to the point where he would go back to back. ... The way you gotta use that, you gotta cycle on and off, but he would do it and think that more" was better. "It got to the point where he thought, 'If I do another cycle, I can gain a little bit more and get a little stronger.' "
Garibaldi also apparently wasn't precise in his use, later telling his mother that he took "about this much" each time he injected, never mentioning an exact dosage.
The last few months of Garibaldi's life were tortured. There were admissions of steroid use, limited as they were. He told his mom first, on a Mother's Day camping trip, and pleaded with her not to tell his father.
She agreed, a decision that later would require her to do considerable repair work on her marriage. Denise said she decided to keep the information from her husband for several reasons: She was fearful how he would react; she believed Rob when he told her this would be his first and only time using and that he was doing it to prepare for the major league draft; she could talk to him freely and openly about the potential dangers of using the drugs; and he told her he would stop if she said his behavior became "too weird."
The major league draft was in June, and Rob saw it as his last chance.
Rob's brother Ray Jr. recalled Rob holed up in his room upstairs on draft day, while Denise remained downstairs panicked about what Rob would do if he wasn't picked.
"He comes out just with this blank look on his face and says, 'I didn't make it,' " Ray Jr. said. "He was totally depressed."
The secret between Rob and Denise ended about a month later when Goelz, the Sonoma State coach, called the Garibaldis to say he had heard Rob was using steroids. Now Ray Garibaldi knew, and he confronted Rob, asking what drugs he was on. Rob erupted and tried to choke his father.
There were further violent outbursts, and Rob even became delusional, prompting Denise to remind him of his promise to stop using steroids if he got too weird. By then, Rob was too far gone. He thought actress Cameron Diaz was going to come watch him play ball and then go on a date with him. He thought he was Jesus Christ. He talked to the television and thought it talked to him.
There were attempts to save Rob -- such as a family intervention where he insisted, "I'm not a drug addict, I'm a ballplayer." The Garibaldis got him to try a rehab center. But shortly before his 28-day stint was scheduled to end, he was asked to leave after assaulting an employee.
Finally, four months after he confided to his mother, Rob stole a gun from a shooting range. About 3:30 the following morning, Oct. 1, 2002, he started to leave the house and was stopped by his father. Rob said he was just going to get some food at Taco Bell and then take a drive -- something he often did.
Three hours later, the Petaluma police were at the door, breaking the news that Rob had shot himself. He lived another 18 hours before dying at a Santa Rosa hospital.
The Garibaldis had been keeping tabs on the mileage of Rob's car -- they took away his use of the car for a time because of his unpredictable behavior -- so they know he drove some 200 miles that morning before returning to Petaluma and parking around the corner from the house.
Ray Jr. likes to believe his baby brother toured all his old baseball haunts -- from Little League fields in Foster City to the ballpark at Santa Rosa Junior College where he was better than anyone had ever been.
It was standing-room-only at the 800-seat church where Rob's funeral was held, befitting the kind of tribute paid to someone who made friends easily and who had once known how to light up a room.
Most of those people wouldn't have recognized the Rob who found himself in the car that October morning, with a gun in his left hand and all hope lost.
For Ray Garibaldi, the bitterness remains palpable, with much of his anger reserved for Major League Baseball and what he sees as public indifference to steroid use.
"I think it's sickening," the father said. "I think the public looks at baseball players as back in the gladiator days. They are just to entertain and if they want to screw themselves up, so what. But the problem is, no matter what anybody says, they are setting the bar for younger kids. And that bar is getting itself all the way down now to the junior high level."
He and Denise see hope, though, and this is what drives them to tell Rob's story.
The Garibaldis have availed themselves not only to legislators trying to address the steroid and supplement problem, but have begun speaking to high school classes about Rob's life. Heather Campbell teaches a sports medicine class at Casa Grande, and she brought in Ray and Denise last May to provide a human touch to her five-week segment on steroids and nutrition.
At one point, the Garibaldis asked the 30-plus kids how many of them knew of high school students that have tried or are using steroids. More than 20 raised their hands. These are the people Ray and Denise Garibaldi desperately want to hear Rob's story.
"We are all better for having him in our lives," Denise said. "I think what happened was so tragic, so I want people to know that out of ignorance and trust, all this can happen."
E-mail Mark Fainaru-Wada at mfainaru-wada@sfchronicle.com.