I don't use sanity (the score), but I do use madness, importing the "madness level" concept from Out of the Abyss.
I don’t care for the sanity rules in the DMG, and I haven’t seen any homebrew or 3rd party sanity rules I’ve really liked. If I were to run a campaign with those kind of lovecraftian themes, and if I did decide that D&D was the system I was going to use for it, I would probably try to hack together something along the lines of Bloodborne’s Insight mechanic, where encounters with the horrific give some mix of advantages and disadvantages. But probably I would use a different rules system.
I'll look it up. ThanksI don't use sanity (the score), but I do use madness, importing the "madness level" concept from Out of the Abyss.