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I know the visual effects add to the "losing sanity" aspect of the game, but it's incredibly tiring to look at in VR, would it be better to leave it on for immersion, or does it not make much of a difference? (first time playing Amnesia)

The first time playing Amnesia, I would highly recommend the desktop version. As for the VR version of the game, I would leave them on for immersion, and disable them if you are getting headaches, motion sickness, or anything that makes the experience less enjoyable.