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Also, if you use it by mistake for some reason, you will die. Straight up death. Game over. Not that that's particularly likely, but it's still a pretty dire consequence.
Worst passive item is probably strange attractor. If you have ludo, brimstone, or a tech-beam, it might be decent, because that way it's able to pull enemies away from you, but otherwise it will often pull enemies directly into your face, since that's where tears come out of.
Worst trinket is cursed skull. How many runs have you had were getting warped out of the room when you have 1 red health remaining would actually have been helpful to you? How often do you have the resources left over to recover that health? And if you have no red health, it will warp you every time you get damaged. It does not work with the lost either.
Worst active is Plan C. Its also the worst item in the entire game, even if you combine every bad item into one, this is still worse than all those combined. I've had runs where plan C has shown up 3 times, because it was in so many different item pools (And yes, I did touch it each time)
Worst Passive is curse of the tower (Or strange attractor). It ruins using demon beggers, blood donation machine, and possibly makes sacrifice rooms lethal. Does it have good synergies yes, can a trinket make is good yes. But it still awful in most runs.
Broken Modem - affects dodging as it affects predictablility of enemies, useless to harmful pickup
The Scissors - extremely weak offensive active, even when spammed, Plan C has seen more use
I'm a fan of the beans. Black Bean and Mega Bean's poison scale with damage, Butter Bean is acceptable for bullet hell bosses and turns into Wait What, Kidney Bean is acceptable on below average runs and Linger Bean is good. The Bean is a fantastic pickup because it scales with damage, has extended poison time and is a one room charge.
Paused bullets are more difficult to predict but if you know their trajectory it makes fast bullets much easier to dodge.
I'd put it at the top of anti-delirium passives, and I've used it in a large number of my winning runs since it's shop available and turns up often. It's amazing how much it slows him down overall.
Cursed Eye usually means quit the run at once, unless it is absurdly mighty and I am willing to take some chances.
Bob's Brain screwed me up royally once with its uncontrollable explosions and I am pretty much never getting it again unless I am immune to such things. Same goes for the Curse of the Tower (or whatever it's called), except it screwed me up more times.
Not sure about about activated items, since those can be disposed of, but many are not particularly useful, and the same goes for trinkets.
Also, I actually like bob's brain. It's not even that bad tbh, it's like using super short range IPECAC from the first game lol
I don't like familiars in isaac in general and will usually let them rot over pick them up, even if they are free. Ghost baby, brother bobby, sister maggy, rainbow baby, mongo baby, ect.
If its not incubus, succubus, acid baby, rotten baby, ect it can stay right there forever. Last thing I need is a junk familiar taking up a good slot in the line for when I find a good one.
I don't even care about conjoined anymore.
Ghost baby can be good if you use it right. Also, lil brimstone is amazing...
Lil brim can be amazing if its in a good position in your familiar line up. Guess what taking the bad familiars first does? It puts him in a bad position in your follower line up. Same with incubus.
After a point if you have too many familiars you can be hit by tears you don't even notice because theres a huge number of low damage tears and followers filling the screen.
I've said for AGES I'd be more inclined to take bad familiars if they would combine together. Similar to super bum. But instead of doing that we got bandaids like duct tape.
Leech Squirrel said bob's brain.
Bob's brain is good, i think they changed it to stick around for like 3 seconds before firing, and if you don't notice you have a massive green thing following you after 3 seconds then tbh you deserve any damage you get from the brain blowing you up...
It was better before boss armor bosses. The delay when entering a room before being able to fire it, is a big reason its so bad and frustrating to use imo.
Its still on my don't take list though. Because it can easily end runs. And isn't a huge positive. While firemind is just as dangerous, firemind is fun. Still, don't take fire mind in greed mode because the ultra greed fight.
I can't do it reasonably good and likely and i still take damage but sometimes i get lucky rock or secret rooms this way.
I don't like the beans tbh but i don't like to be in melee range in serious isaac runs unless i get maw of the void or something like that.
Cursed eye is something i never pick up.
Cursed Skull. This is the one trinket I'll never use no matter the context. Being taken out of a room upon getting hit will do more harm than good in almost every single situation where it applies.
Worst passive:
Cursed eye. I can find a reason to pick up almost any item there is, but the only reason this thing is even in my collection grid is because of curse of the blind. It's like cursed skull but worse since it can happen any time you're trying to fire tears. I'll even reset the game if curse of the blind graces me with this thing because it'll save the trouble of having to fight a final boss 7+ times before I finally die.
Worst active item:
Breath of life. This thing's effect is borderline useless unless you master how it works to get yourself free blood donations and devil beggar payouts. Brief invincibility is completely useless in combat since you're more likely to get yourself hit trying to benefit from it than just dodging whatever the enemy sends your way.
A very close second for this would be dead sea scrolls. I probably won't even pick this up.
Fun fact: the very first time I used dead sea scrolls in the original Isaac gave me the kamikaze effect as I used it during the mom boss. It almost cost me my very first "win".
I can make use of almost every single item in the game. I'll even make good use of the bean if that's the only active I can get my hands on. However, I'll never pick up the items above no matter what.