I like how it looks, how it sounds. The bulls, environments... Its all quite well polished and put together!
I want to talk about defend mechanic and items though. Thing is - currently you want to use items/defend only when eveything went poorly beforehand. So basically, when you are already on low sanity. Pills become useless (as damage is getting higher), Defend loses sanity and you also unable to utilize it by then.
I went with 0 defend or items used up until last stage basically.. and then I died after unlucky attempt to escape (failed like 5 in row - its quite unlucky at this point!), thinking that using pills would at least give me time to use defend after (idk why i though that. but here is that). It almost always safe to just run without taking defend. And when stuff start to be harder - you already failed, since you are already at low sanity to use anything.
Maybe make running not as powerful at start so player will get used to use defend and managing of sanity? Also still not sure how to use pills, since in combat they are useless - you get hit right after and chances are - for more than pill heals for.
But game is fun and has even more potential.