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1. Dr Fetus/Ibutac
2. Pyromania
3. Gnawed Leaf
4. D6
5. Dark Bum
6. Serpents kiss
7. Sackboy
8. Humbling bundle
9. Any passive Flight item
10. Continuum tears
11. No.2
12. Host Hat
13. Shop Restock
14. Piercing tears
15. Crystal Ball/Card Deck/Rune bag/Prayer card
16. Holy mantle
17. The nail/Satanic Bible
18. Sad Bombs
19. Holy light
20. Black candle
Honorable mentions
Holy shield
Cube of meat/bandges
Glitter bombs + Scatter bombs
Guppy items
Rotten baby
I dislike all items that change my attack into charged attacks after ages of farming coins as Azazel for the shop donation machine. I also might be alone here in that I don't like magic mush because of the size increase.
- brimstone
- stop watch
I'm not accounting for combos in this list, but even if I was god tier would be the same because stop watch is just that good and brimstone has the best DPS combos: b + tammy's head and b + homing shots
Then there's S+ tier, which includes items that are game breaking but really depend on other items to make the most out of their potential:
- dead cat
- holy shield
Dead cat means free devil trades plus free spiked door rooms, plus one less item for guppy's transform (and extreme ease to get the other two due to the other reasons). Holy shield is also gamebreaking. Yet you need to be able to output decent damage because those two items won't carry you through long fights. Now, "decent damage" is already a prereq for an OP game, so that's why these two still qualify at least one cut above the rest.
On S tier we have:
- cricket's head
- 20/20
- abbadon
- daddy long legs (not recommended with The Lost since you lose control on where / when exploding enemies, including teal / blue champions, die.)
On tier S- we would have items that can be great but are too situational to qualify higher:
- humbling bundle
- head of krampus / scissors (the ones that let your body chase enemies)
- joker card
- lil brimstone
Humbling bundle is next to useless if you don't land it early in the game, but if you can get it early on congratulations, you're on your way to OPness. Scissors and head of krampus are some of the best boss killers. They have long recharge time plus take your active item slot, but they can take down bosses and clear big rooms in no time with near zero risk (from caves onward you pretty much can recharge them before entering the boss room). Tammy's head only surpasses HoK once you can get huge base damage, plus piercing shots, plus ouija board effect. In most games HoK will beat TH. Joker card lets you land a devil deal before you enter the boss room, but -more important- lets you enter a devil room you might not see otherwise, at the precise moment you have the hearts to make deals. Lil' brimstone is like brimstone but with worse damage scaling and no synergies, plus you need to get it before you get any other "followers" or you won't be able to target properly.
I don't like items that change tears behavior, brimstone being the obvious exception because it's just too good. Ludovico is very strong when it works but it has serious shortcomings (no AoE, no knockback, can go offscreen on big rooms, etc.). The remote controlled blue fly (not ludovico's) is good but as soon as my shots become half good I no longer use it. Mega fetus is strong but it turns some enemies into a royal PITA (like burrowing ones - you actually need to anticipate when they will unburrow). Dr fetus is too slow; Ipecac is better but it's more unpredictable and risky.
I find the Soul to be pretty unreliable personally, especially compared to some of the other projectile-blocking items. Having 3 orbitals almost guarantees you take no projectile damage ever, Dry/Farting Baby and Samson's Chains can be positioned to completely block projectiles from an enemy (unless they shoot curving shots, which accounts for all of like 3 enemies in the game), etc.
The Soul on the other hand varies in strength, and at its low point it basically just turns off, which means you always have to pay attention to whether it's actually working. Also it doesn't block everything. Som fast-moving shots usually keep enough momentum to hit you unless your aura happens to be at full power, and homing shots just straight up ignore it. With some of the other items, you can literally just stand still and not be in any danger, but with the soul, you still have to dodge everything, you just get more of a safety window when doing so. I'd take it over Mask of Infamy and Circle of Protection because those are just straight up RNG, but not over stuff that I can actually control.
I will admit, though, it's probably my favorite item to have when challenging Mega Satan. Repelling his fire waves, while really not necessary, is one of the coolest looking things in the game.
1. 20/20
2. Godhead/Sacred Heart
3. D100
4. D6
5. Holy Mantle
6. More/Theres Options
7. Sackhead
8. Tech X
9. Pyromaniac
10. Censer
11. The Wafer
12. Brimstone
13. Mom's Knife
14. Cricket's Head/Body
15. Tech .5
16. Magic Mushroom
17. Proptosis
18. The Pact
19. Sacrifical Dagger
20. Eden's Blessing
Honorable Mentions:
Death's Touch
Goat Head
SMB Super Fan
Scorpio
Rubber Cement
Rotten Baby
Daddy's Longlegs
Pinking Shears
Abbadon
Trinity Shield
Stopwatch
It's good. I'd say it's better than the Body but less useful as the Mind. The projectiles don't always deflect and the soul hearts could be useless depending on your health at the time.