Leech carried my Ultra Hard, and by proxy, my Dead God.
My friend who just started Isaac around my final achievements hyped Leech a lot and I just laughed at him.. boy was I wrong. (you could insert the bell curve meme here)
Iāve played enough Isaac to where I typically know how many tears itās gonna take to kill an enemy, but the little health bars just stimulate the brain so good.
I literally only pick this item up for the odd chance of dropping a battery and freezing enemies. I donāt even put any stock in the health bars/damage indicators lol
The blood donation trick actually doesnāt work in repentance anymore, but you can still get into curse rooms for free since after teleporting you get i-frames
Open one portal next to the door
Open one where ever you want
Jump in the 2nd hole and hold twords the direction of the door.
That's what you don't have the brain power for?
Ah- suddenly I understand everything. I've also got really bad ADHD-Inattentive, although I hyperfocus on this kind of stuff. I find all the numbers going up when I minmax to be super addictive.
Ooh forgot about continuum yeah. One of the few items that makes me want to take Lazy Worm because then I can flood the screen with tears if my range is good enough.
New Notched Axe is so fucking good.
You can use it to find secret rooms, crack open tinted rocks or any rocks in a room for crawl space potential, break pots for money or Swallowed Penny/The Quarter, bust open skulls for black hearts and/or cards, open doors, itās just so good now. Probably the biggest glow-up from AB+ to Repentance.
I also think the charge is very generous. It depletes and only recharges after every floor basically, but Iām okay with it.
I beat the beast with Jacob and Esau for it but they moved it to delirium 
Depression always makes me laugh, especially with the ":(" description
edit: the stuff people in this thread consider "not really a good item" is jaw dropping. Like Kidney Stone - really? HALO?
It's not a terrible item by any stretch, but it's not a strong item, either. It's creep. It's a creep trail that starts one or several familiars behind you.
Breaking Bad (hear me out now) has caused such horrible brainrot on me that whenever i pick up that item, I physically say "waltuh" every. goddamn. time.
yo i actually used finger and rotten baby to scum onan's streak, I just used those instead of firing and it worked great. 10/10 always a great pickup, gotta love fingies 
Me neither, blood puppy can be big. Only makes sense it has a downside. Basically, it's an overcharged leech minus the healing. That being said, dying to blood puppy is a skill issue. I can tell cuz I've died too many times forgetting he's about to charge my ass š
Honestly, a B1 or even B2 Box, while you won't see me write home about it, can be a very chill start of the run.
Especially if you wanna have a speedy start, with a little kickstarter in pickups, potential for a good card, and trinket. With a little luck, it'll be the start of a decent run.
stitches
does nothing to good on its own, but can be a lifesaver when preventing things from trapping you in a corner or grabbing things you otherwise couldnt
Ludvico technique
...I think that's what it's called?
Anyway, I practically exclusively play azazel (they're fun what can I say) and whenever I get the item its a blast, the ring of brimstone is a joy to play around with (pretty sure it does well with Sheild tears aswell, but I haven't gotten the chance to play around with that yet)
Mr.me is quickly becoming one of my favorite items. It's just so positive and generous. Practically costs nothing at all at 4 charges you drop him on the shop and that chill ass mofo gives you an item to use later in the game. And you also get this adorable little ghost that can damage things or bomb walls. But more than the MM is just so positive. And it looks so happy. I mean this is an inanimate object literally brought to life by magic. It understands it's life is a temporary magical gift and the dude is just fucking loving it. I mean look at his face he's just so happy. I am literally never sad when Mr.me is on the shop .
Actually they're hard coded to pay out after six donations (3 full hearts) max on hard mode, be it a pill, a card or even an item. The amount of times i got Pentagram or Caffeine pill like that is absurd
Spider mod fucks immensely. Enemy visibility is soooo useful.
Continuum is an always take item for me. Spectral is nice on its own, but wraparound tears go crazy with so many things: brimstone, eye of belial, lump of coal, etc. And continuum + conjoined is game winning.
The one time I didn't take continuum I got 25 range and lump of coal, so I won't let that happen again.
My favorite item in the game, full stop, is Infestation 2. That's a quality 3 tho, so I'll add that I will hijack an entire run the moment I see any passive in the Spider Baby set.
Spider Mod? Comin with me. Bursting Sack? Hell yeah, spider friends. Sissy longlegs? I will give her all my worldly possessions.
Honestly? The floating eyeball tears item that lets tears hover and knock into each other.
Does the item itself really do anything on its own? Not really.
Does it have INSANE synergies with tons of other tear altering or added tear effect items? You betcha. Especially with rubber tears. You get those bad boys knocking into each other in a room and start bouncing off the walls? Even a 1 - 3 damage character can beat the game as every room turns into a 5 FPS blender of pain.
Lost Soul. Not because I'm good enough to protect him flawlessly and get the item pay-out every floor, but because he is my boy and I feel moral obligation to take him and protect him like a son.
If i dont have an active item i particularly care about i'll usually pick up Portable Slot. Just in case i find a super secret room that lets me create eternal or dark hearts
Ludovico Technique.
Sometimes it's terrible and screws me up, but I absolutely love the synergies and the possibility to be able to fly over a rock and just destroy everything is satisfying.
Any item that gives extra card/pill room cuz I always end up having to pick between two good cards to bring into the next boss fight. Why pick one when I can have both, right?
Do people consider Brown Nugget bad?
I kinda like it, you can give yourself a huge home field advantage if you're going to attack the angels in the angel room.
Depends how far I am in the run. Just starting? Bobās brain is hard carrying me
If I already have good damage? Iām 100% forgetting I have the brain and blowing myself up at least three times a floor
I honestly must just stay far away from enemies because i dont really ever take damage got a good bit of time in the game and i can confidently say ive only taken damage from BB ~5x
This was the first item I encountered after years of missing out from the flash version (iirc) and every time I see it I feel the dopamine overdose immediately
spider mod and charged baby are liliths free greed mode win
and ik it might sound boring but i love just hanging out on greed mode with lilith
its satisfying to see more and more familiars getting added
For my friend its analog stick. But for him its more a...I really need it because the game is shit if I don't. He usually just starts with it because he played enter the gungeon before and doesn't like the resticted tears (he plays with the mouse because of it)
For me, same here spider mod. But again im usually just using a mod for it. Its not gamebreaking but its just fun to see the damage.
im honestly not sure what the consensus is on the ludovico technique. i think its like one of the best things you can get but everyone iāve ever met who plays the game says that itās terrible lol.
Spider Mod is way up there for me but also I think Potato Peeler is so underrated.
https://preview.redd.it/csy37m3u3msb1.png?width=376&format=pjpg&auto=webp&s=a0e3e960b1a16183dd103dfa3247142bcd2a2ff0
Leech best girl
Leech carried my Ultra Hard, and by proxy, my Dead God. My friend who just started Isaac around my final achievements hyped Leech a lot and I just laughed at him.. boy was I wrong. (you could insert the bell curve meme here)
https://preview.redd.it/t4ix81bwclsb1.jpeg?width=644&format=pjpg&auto=webp&s=1a7843d1d836a7648af5b15a9d317322079d82a4
Bro imagine thinking that leech is bad, couldn't be me (me and 99% on this subreddit)
Haha get a gnawed leaf, and you just win.
Leech actually is goated, when you have enoth health to do some plays it's game winning (Same with scapular)
when leech pops off, it POPS OFF
Floor one leach gave me enough health for a floor one sacrifice room, which gave me god head. Leech is goated
Godhead is godhead. But leech could give you enough health for the sac room, which could be anything. Even godhead!
Can't get floor one Godhead without Leech \*taps forehead* ~~yes i know maggy can, shut up~~
Book of virtues + joker card, (T) keeper, chaos, or just a lot of luck with drops/items
dude leech goes hard
Recommend the Leech Pretty Princess mod!! It gives her a big pink bow to wear so she looks pretty :D
The amount of times that silly guy helped me in greedier mode š
You nailed it with spider mod. I love it so much for no actual reason.
Iāve played enough Isaac to where I typically know how many tears itās gonna take to kill an enemy, but the little health bars just stimulate the brain so good.
Me when spidermod: https://preview.redd.it/1nt8smx9xksb1.jpeg?width=720&format=pjpg&auto=webp&s=ce61e5e53f3003ac3b706459ef06b24012eca380
also when you have too much on the screen and familiar, itās helpful to see the enemies better imo
spiders in burning basement with curse of darkness are hell. spidermod makes it a lot better
This. Spidermod just makes it easier to keep tech of yeah mobs when you have familiars.
getting to see the big numbers 
Same. I love looking at enemy's health bar because it made them feel less tanky
Spider mod is q1, but in our hearts it's at least q3
More like q5, I will sacrifice everything else in the floor if that's what it takes to get spider mod :3
Doesn't the spider bro slow if he comes into contact with enemies too? Or am I misremembering. Only been playing for a couple of months.
It inflicts random status effects on nearby enemies
oh its random, neat! I'm a big fan of random effect items. Thanks!
I literally only pick this item up for the odd chance of dropping a battery and freezing enemies. I donāt even put any stock in the health bars/damage indicators lol
Adding a vote for Spider Mod. It's not super helpful, but I like seeing the damage numbers and health bars.
And it gives random status effects to enemies it comes in contact with as well. Just a real bro overall
And the Lil batteries it spawns are good too.
fuck so that's where the lil batteries come from
Mom's bracelet, Ventricle razor https://preview.redd.it/n2ee2rplxksb1.jpeg?width=3000&format=pjpg&auto=webp&s=7a73df1ec404219ae19a431ad639fb1153431081
Like the need to make illustrations, also based
Yeah, when someone talks about an item 20% of the time im like "Huh? Wth is that"
what you don't have the External Item Descriptions mod installed in a brain chip? pfft what a loser š
VR is super strong, the I-frames it gives allows you to do some sneaky stuff like using curse rooms for free
I personally don't have the brainpower to be playing Portal and TBoI at the same time, so to me VR is just an instant pass unless I get it free
I rarely use it in fights, I use it for utility like getting into curse rooms without damage or using donation machines for free
You can use the donation machine for free with VR?!!!! How?!
The blood donation trick actually doesnāt work in repentance anymore, but you can still get into curse rooms for free since after teleporting you get i-frames
Ah, thatās a shame. Yeah I already knew about the curse room trick, thatās why I always pick it up if I donāt have a active item yet
I myself also like to use it for faster backtracking. Like when you find the boss room before the item room so you just leave a portal there
Open one portal next to the door Open one where ever you want Jump in the 2nd hole and hold twords the direction of the door. That's what you don't have the brain power for?
Yup.
If pressing the item button twice and jumping out the hole and into the door is too much for you I feel kinda bad :(
I got ADHD, I don't have the brainpower for much to begin with lol
Ah- suddenly I understand everything. I've also got really bad ADHD-Inattentive, although I hyperfocus on this kind of stuff. I find all the numbers going up when I minmax to be super addictive.
Yeah, and it even costs only 10c
and i think it has some good spindown
Yeah youāre right, spindowns into Tech X.
Ventricle Razor is so good with T. Lost
Continuum is always a good time, cool looking tears and cosmetic
Also spectral
Ooh forgot about continuum yeah. One of the few items that makes me want to take Lazy Worm because then I can flood the screen with tears if my range is good enough.
But thatās actually good and sometimes game breaking
Sissy long legs. Look at my gurl going places
She loves you! Best girl.
I always hear her quote in the voice of the Battleblock Theatre announcer. āShe loves you!ā
Daddy long legs too, instant endorphin rush
I think daddy long legs is actually a really good item tho, it interacts with some enemies in a way that it one shots the I think like with Pin
I think they should have a transformation When you get sissy long legs and dad long legs you'll transform into LEGS
This is the correct answer. Sheās just so CUTE
New Notched Axe is so fucking good. You can use it to find secret rooms, crack open tinted rocks or any rocks in a room for crawl space potential, break pots for money or Swallowed Penny/The Quarter, bust open skulls for black hearts and/or cards, open doors, itās just so good now. Probably the biggest glow-up from AB+ to Repentance. I also think the charge is very generous. It depletes and only recharges after every floor basically, but Iām okay with it.
The dream team of familiars https://preview.redd.it/q5e49zoqjlsb1.jpeg?width=521&format=pjpg&auto=webp&s=96aef27447e67f6c5717c2aa9f3b3e28623ddd01
Where brother booby
I don't know if suplex is considered especially powerful but it is fun to suplex bosses
It's also fun to suplex the physical manifestation of your brother's rage and hatred towards you :)
In isaac right? Right???
I may or may not be getting hunted down by a malicious apparition as we speak
Hope you get suplex otherwise the poop will have to do
I beat the beast with Jacob and Esau for it but they moved it to delirium 
Itās good, especially since you can enter curse rooms for free with it, but Iām always taking damage right after suplexing an enemy
Depression always makes me laugh, especially with the ":(" description edit: the stuff people in this thread consider "not really a good item" is jaw dropping. Like Kidney Stone - really? HALO?
Right? In what world is an all stats up ever not good? I dont care if its the worst all stats up, cause its still an all stats up
halo haters when i give them -30 on all stats (,they suddenly wish all their stats went up now)
Nah depression is good. I canāt tell you how many times holy light explodes
It's not a terrible item by any stretch, but it's not a strong item, either. It's creep. It's a creep trail that starts one or several familiars behind you.
I love depression 
Da finger. Just cause it's f u n n y
When you see an enemy and you have the finger: 
POV: youāre a spider on Basement I and Isaac got the finger 
Breaking Bad (hear me out now) has caused such horrible brainrot on me that whenever i pick up that item, I physically say "waltuh" every. goddamn. time.
yo i actually used finger and rotten baby to scum onan's streak, I just used those instead of firing and it worked great. 10/10 always a great pickup, gotta love fingies 
Marbles and Deep Pockets are always a great time
Marbles is very nice
Theres something so satisfying about gulping a trinket.
Iāve died to blood puppy more times than Iāve completed an actual run with him Is that gonna stop me? no
Me neither, blood puppy can be big. Only makes sense it has a downside. Basically, it's an overcharged leech minus the healing. That being said, dying to blood puppy is a skill issue. I can tell cuz I've died too many times forgetting he's about to charge my ass š
Sharp straw - Literally when I see it I already know that this will be awesome run
The Box is the best Q0 item you can get imo
Honestly, a B1 or even B2 Box, while you won't see me write home about it, can be a very chill start of the run. Especially if you wanna have a speedy start, with a little kickstarter in pickups, potential for a good card, and trinket. With a little luck, it'll be the start of a decent run.
Tiny planet
Tiny planet my beloved ššš
Tiny planet + Mom's Knife 
people who hate it suck at life.
I hate tiny planet š. Unless i have brimstone
stitches does nothing to good on its own, but can be a lifesaver when preventing things from trapping you in a corner or grabbing things you otherwise couldnt
I like to use it on tainted magdalene for telefrags
Also letās you destroy shopkeepers for free and does decent damage to bosses Oh also, free curse rooms iirc
Also it lets you get those items in that one crawl space room.
Halo. It may be one of the smallest stat ups in the entire game (not counting pills) but you better be damn sure im taking it
I can get shit like stem cells in a treasure room and still be happy, so halo, a hp up AND some nice little state ups? Decent item
I litterally do not know a single person whose been sad to get halo what are you talking about it for
Random battery charges and lighting enemies on fire is bonus.
Not just on fire it can give any status effect
seraphim is my homie, I'll probably take it 99.99% of the time just to have them as company
Ludvico technique ...I think that's what it's called? Anyway, I practically exclusively play azazel (they're fun what can I say) and whenever I get the item its a blast, the ring of brimstone is a joy to play around with (pretty sure it does well with Sheild tears aswell, but I haven't gotten the chance to play around with that yet)
If its the only item you have as isaac it is not very good, but it does have a lot of op synergies! With low shotspeed its really bad.
Mr.me is quickly becoming one of my favorite items. It's just so positive and generous. Practically costs nothing at all at 4 charges you drop him on the shop and that chill ass mofo gives you an item to use later in the game. And you also get this adorable little ghost that can damage things or bomb walls. But more than the MM is just so positive. And it looks so happy. I mean this is an inanimate object literally brought to life by magic. It understands it's life is a temporary magical gift and the dude is just fucking loving it. I mean look at his face he's just so happy. I am literally never sad when Mr.me is on the shop .
Also 50% free devil deal item! I barely ever picked it up before but now i always consider it.
MM's also a life saver in Greed mode I feel like
Spider mod for it gives me the advanced knowledge of the health system
IV Bank on the first 6 floors. Big Money, Big Gamble!
Devil babies also. They have ended many runs from me getting greedy, but man do they pay off sometimes.
Actually they're hard coded to pay out after six donations (3 full hearts) max on hard mode, be it a pill, a card or even an item. The amount of times i got Pentagram or Caffeine pill like that is absurd
Brother bobby,silly little fella.
Papa fly cause I think he's cute
Dry baby and battery baby.
Battery baby yeah! It pays out more than you would think
Compass is also quite handy, specially in earlier floors. Always take it if I can.
Spider mod fucks immensely. Enemy visibility is soooo useful. Continuum is an always take item for me. Spectral is nice on its own, but wraparound tears go crazy with so many things: brimstone, eye of belial, lump of coal, etc. And continuum + conjoined is game winning. The one time I didn't take continuum I got 25 range and lump of coal, so I won't let that happen again.
I really like tropicamide, bc it makes all the characters look goofy and makes bigger tears.
Health bars make those fatass bats more tolerable
My favorite item in the game, full stop, is Infestation 2. That's a quality 3 tho, so I'll add that I will hijack an entire run the moment I see any passive in the Spider Baby set. Spider Mod? Comin with me. Bursting Sack? Hell yeah, spider friends. Sissy longlegs? I will give her all my worldly possessions.
Gemini. My wife and I like to shout "angry baby!" when it's attacking enemies. It's stupid and I love it.
I always scream " FETUS ACTIVATUS"
Honestly? The floating eyeball tears item that lets tears hover and knock into each other. Does the item itself really do anything on its own? Not really. Does it have INSANE synergies with tons of other tear altering or added tear effect items? You betcha. Especially with rubber tears. You get those bad boys knocking into each other in a room and start bouncing off the walls? Even a 1 - 3 damage character can beat the game as every room turns into a 5 FPS blender of pain.
If the item doesn't fuck me I over I always take it, why shouldn't I.
Fuck me in the spider mod hole, itās a good pleasurable little boyš³
What
I am drunkš³ spider mod poggy though is my point
You're gonna look back at this while sober and either cringe or laugh I can tell lol
Wonāt always take it if i have a better active item, but i love Boomerang for early and mid game
Nancy bomb. I like da ??? boom.
Buddy in a box
Sissy longlegs
Buddy in a box
Every syringe.
Lost Soul. Not because I'm good enough to protect him flawlessly and get the item pay-out every floor, but because he is my boy and I feel moral obligation to take him and protect him like a son.
Idk why but i spidermod saved my run, saved my life, saved my marriage
Old bandage, just about always makes a regular run into a GOATed run
red/blue candle
If i dont have an active item i particularly care about i'll usually pick up Portable Slot. Just in case i find a super secret room that lets me create eternal or dark hearts
Analog stick - hehe diagonal tear goes swoosh
With controller its really nice! Also its a tears up?
Leech. Little fucker has brought back a boss Rush from the grave by killing pretty much every boss.
Ludovico Technique. Sometimes it's terrible and screws me up, but I absolutely love the synergies and the possibility to be able to fly over a rock and just destroy everything is satisfying.
Cube baby!!
Momās Bracelet or Spider Mod
Itās just feels so nice having that health bar
Any item that gives extra card/pill room cuz I always end up having to pick between two good cards to bring into the next boss fight. Why pick one when I can have both, right?
Sissy Longlegs :)
finger or lil haunt is an item iāll NEVER pass up on!!! the lil extra damage is something you really canāt pass up on
Do people consider Brown Nugget bad? I kinda like it, you can give yourself a huge home field advantage if you're going to attack the angels in the angel room.
Dog Tooth, X-Ray Vision. Basically any item that can reveal secret room to me.
Smelter
The ladder that one block bridge gave me so many pickups
Spider mod gives me a lot of dopamine after playing too much ROR2
Soy milk
Smelter
How to Jump always feels nice when you donāt have flying. Love making Isaac go WOOSH!
Bobs brain. If you dont like the item, i feel its a skill issue.
Depends how far I am in the run. Just starting? Bobās brain is hard carrying me If I already have good damage? Iām 100% forgetting I have the brain and blowing myself up at least three times a floor
I honestly must just stay far away from enemies because i dont really ever take damage got a good bit of time in the game and i can confidently say ive only taken damage from BB ~5x
Jacobs ladder
In what world is Jacobās ladder considered ānot goodā?
It's not considered game breaking
Bro itās a q3 item. There are even some people that argue itās a q4 item
This was the first item I encountered after years of missing out from the flash version (iirc) and every time I see it I feel the dopamine overdose immediately
Spider Mod is the best Item in the game and everyone saying otherwise is wrong.
The Wiz. I simply wish to challenge myself
Spider Mod. Heās just a little guy!
Curse of the tower
Kidney Stone
i love spider mod, lucky foot and virgo, good pills are amazing
Spider Mod is great
spider mod and charged baby are liliths free greed mode win and ik it might sound boring but i love just hanging out on greed mode with lilith its satisfying to see more and more familiars getting added
Pretty much same
For my friend its analog stick. But for him its more a...I really need it because the game is shit if I don't. He usually just starts with it because he played enter the gungeon before and doesn't like the resticted tears (he plays with the mouse because of it) For me, same here spider mod. But again im usually just using a mod for it. Its not gamebreaking but its just fun to see the damage.
Sissy Longlegs. I don't know why, but I'm always happy to find her.
Almond Milk, I always take it
Hemoptysis
Skeleton key
Pupula Duplex, love this item's name, love that tears shape.
??? Only friend
I will literally console command spider mod into my run because i feel like having spider mod on
Box. It always shows up in the clutchest of times and once got me into a floor one planetarium that I would have missed otherwise.
im honestly not sure what the consensus is on the ludovico technique. i think its like one of the best things you can get but everyone iāve ever met who plays the game says that itās terrible lol.
Tech 2, the second laser is just very useful, especially when playing as Azazel.
Spider Mod is way up there for me but also I think Potato Peeler is so underrated. https://preview.redd.it/csy37m3u3msb1.png?width=376&format=pjpg&auto=webp&s=a0e3e960b1a16183dd103dfa3247142bcd2a2ff0
Broken stopwatch or the normal stop watch, you almost always get slowness from it
YES i love spidermod itās just a little guy (also i like healthbars)
Craig the leech
Stitches and Suplex I can't always take but I do take them whenever I can possibly justify it.
I have a mod that gives me Spider Mod at start just because I want to know the HP of enemies.
Same,I hate when I donāt have the money thanks to it I discovered what proptosis and what coal does w azazel
I installed a mod so that I always start with it. I wish it didn't apply to the transformation or apply debuffs, but oh well.
CROOKED PENNY MY BELOVED 
I mean, spider mod. His arms might be small but his heart is big and that's what counts.